Amy Jennifer Malia Crockford, is a
Student In An Organized Health Care Education/training Program based in Portland, Oregon. Amy Jennifer Malia Crockford is licensed to practice in * (Not Available) (license number ) and her current practice location is
5200 Sw Macadam Ave, # 580, Portland, Oregon. She can be reached at her office (for appointments etc.) via phone at
(503) 231-7854.
NPI number for Amy Jennifer Malia Crockford is 1104102813 and her current mailing address is 5200 Sw Macadam Ave, # 580, Portland, Oregon. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1104102813.
Healthcare Provider's Profile
Full Name | Amy Jennifer Malia Crockford |
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Gender | Female |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 5200 Sw Macadam Ave, Portland, Oregon |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1104102813
- Provider Enumeration Date: 10/26/2011
- Last Update Date: 12/02/2015
Medical Identifiers
Medical identifiers for Amy Jennifer Malia Crockford such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1104102813 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101Y00000X | Counselor | (* (Not Available)) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Amy Jennifer Malia Crockford is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Amy Jennifer Malia Crockford, 5200 Sw Macadam Ave, # 580, Portland, OR 97239 Ph: () - | Amy Jennifer Malia Crockford, 5200 Sw Macadam Ave, # 580, Portland, OR 97239 Ph: (503) 231-7854 |
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