Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 02-07-56 | OR |
N | 101YP2500X | Professional Counselor | 56141 | OR |
NPI | 1003972894 |
---|---|
Provider Name | Wanda A Scott |
First Address | Oregon City, OR 97045-4035 |
Second Address | Happy Valley, OR 97086-7624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 18/12/2012 |