Provider Demographics
NPI:1235833534
Name:YOUNG GREENSMITH, MAGGIE MCKENZIE
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:MCKENZIE
Last Name:YOUNG GREENSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 SE REEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5445
Mailing Address - Country:US
Mailing Address - Phone:503-704-5769
Mailing Address - Fax:
Practice Address - Street 1:12150 SW WESTFALL RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-7207
Practice Address - Country:US
Practice Address - Phone:503-545-8688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator