| Wake Robin | |
|
1520 Plaza Street Nw Suite 100 Salem OR 97304 | |
| (503) 205-4362 | |
| (503) 205-0193 |
| Full Name | Wake Robin |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1520 Plaza Street Nw, Salem, Oregon |
| Authorized Official Name and Position | Suzy K Venzke (BILLING MANAGER) |
| Authorized Official Contact | 5032054362 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Robin 3415 Se Powell Boulevard Portland OR 97202 Ph: (503) 205-4362 | Wake Robin 1520 Plaza Street Nw Suite 100 Salem OR 97304 Ph: (503) 205-4362 |
| NPI Number | 1336401017 |
|---|---|
| Provider Enumeration Date | 06/08/2012 |
| Last Update Date | 03/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336401017 | NPI | - | NPPES |
| 145946 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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