Provider Demographics
NPI:1154462737
Name:OREGON SCOTTISH RITE CLINICS
Entity Type:Organization
Organization Name:OREGON SCOTTISH RITE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-226-1048
Mailing Address - Street 1:5125 SW MACADAM AVE
Mailing Address - Street 2:200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3809
Mailing Address - Country:US
Mailing Address - Phone:503-226-1048
Mailing Address - Fax:503-226-1049
Practice Address - Street 1:5125 SW MACADAM AVE
Practice Address - Street 2:200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3809
Practice Address - Country:US
Practice Address - Phone:503-226-1048
Practice Address - Fax:503-226-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNON-PROFIT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR170100Medicaid
OR838353000OtherBLUECROSS PROVIDER