| |
999 Abernethy Rd Oregon City OR 97045-1175 | |
(503) 891-6200 | |
Not Available |
Full Name | |
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Speciality | Social Worker |
Location | 999 Abernethy Rd, Oregon City, Oregon |
Authorized Official Name and Position | Slade Wolf (OWNER) |
Authorized Official Contact | 5038916200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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999 Abernethy Rd Oregon City OR 97045-1175 Ph: (503) 891-6200 | 999 Abernethy Rd Oregon City OR 97045-1175 Ph: (503) 891-6200 |
NPI Number | 1629602404 |
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Provider Enumeration Date | 03/02/2020 |
Last Update Date | 02/04/2025 |
Certification Date | 02/04/2025 |
Medicare PECOS PAC ID | 0941676878 |
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Medicare Enrollment ID | O20230816002635 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629602404 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Slade B Wolf |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1679879316 PECOS PAC ID: 2860868791 Enrollment ID: I20221018003002 |
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