| Patricia Wafer Lcsw Llc | |
|
753 Se Main St Ste 104 Roseburg OR 97470-3938 | |
| (541) 784-6935 | |
| (541) 229-2233 |
| Full Name | Patricia Wafer Lcsw Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 753 Se Main St Ste 104, Roseburg, Oregon |
| Authorized Official Name and Position | Patricia Wafer (OWNER/THERAPIST) |
| Authorized Official Contact | 5417846935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patricia Wafer Lcsw Llc 753 Se Main St Ste 104 Roseburg OR 97470-3938 Ph: (541) 784-6935 | Patricia Wafer Lcsw Llc 753 Se Main St Ste 104 Roseburg OR 97470-3938 Ph: (541) 784-6935 |
| NPI Number | 1902361082 |
|---|---|
| Provider Enumeration Date | 02/04/2019 |
| Last Update Date | 02/04/2019 |
| Medicare PECOS PAC ID | 6103166244 |
|---|---|
| Medicare Enrollment ID | O20190327001459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902361082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Patricia Wafer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649393661 PECOS PAC ID: 8820338965 Enrollment ID: I20190327001543 |
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