Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 2012033735 | MO |
Y | 1041C0700X | Clinical Social Worker | L6954 | OR |
NPI | 1003154774 |
---|---|
Provider Name | Beverly Kay Riley |
First Address | Portland, OR 97208-3158 |
Second Address | Medford, OR 97504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2013 |
Last Update Date | 30/05/2018 |