Provider Demographics
NPI:1114661899
Name:EADDY, CHAD EMMANUEL (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:EMMANUEL
Last Name:EADDY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NE MARKET DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-7000
Mailing Address - Country:US
Mailing Address - Phone:503-660-0600
Mailing Address - Fax:
Practice Address - Street 1:1800 NE MARKET DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-7000
Practice Address - Country:US
Practice Address - Phone:503-660-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker