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NPI Code Detail

MEDICARE: PHYLLIS STEWART CADCII

MEDICARE: PHYLLIS STEWART CADCII
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor94-10-133OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972582666
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS STEWART CADCII
Provider Business Mailing Address
First Line : 17645 NW SAINT HELENS RD
Second Line :
City : PORTLAND
State : OR
Zip : 97231-1729
Country : US
Telephone Number : 503-621-1069
Fax Number : 503-621-0200
Provider Business Practice Location Address
First Line : 1776 SW MADISON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1715
Country : US
Telephone Number : 503-224-1044
Fax Number : 503-621-2235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 07/08/2007

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1093794687 — KATHLEEN A WALKER RN
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1700857497 — PAULA LYNN FOTHERGILL M.S., CADCII
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Directions to “ PHYLLIS STEWART CADCII” Practice Location

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