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528 Cottage St Ne Ste 401 Salem OR 97301-3861 | |
| (503) 583-8537 | |
| (503) 343-3331 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 528 Cottage St Ne Ste 401, Salem, Oregon |
| Authorized Official Name and Position | Elizabeth Delgros-ryan (OWNER) |
| Authorized Official Contact | 4127593919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
528 Cottage St Ne Ste 401 Salem OR 97301-3861 Ph: (503) 583-8537 | 528 Cottage St Ne Ste 401 Salem OR 97301-3861 Ph: (503) 583-8537 |
| NPI Number | 1073219507 |
|---|---|
| Provider Enumeration Date | 02/06/2023 |
| Last Update Date | 10/06/2023 |
| Certification Date | 06/02/2023 |
| Medicare PECOS PAC ID | 8325584485 |
|---|---|
| Medicare Enrollment ID | O20240724004534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073219507 | NPI | - | NPPES |
| 500817801 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Christa Lynn Whittington |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316616808 PECOS PAC ID: 9436697463 Enrollment ID: I20240821001703 |
| Provider Name | Elizabeth Delgros-ryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023389970 PECOS PAC ID: 0143766204 Enrollment ID: I20240828004402 |
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