Provider Demographics
NPI:1518180355
Name:NEJEDLO, DENISE LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LYNN
Last Name:NEJEDLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3886 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3835
Mailing Address - Country:US
Mailing Address - Phone:503-999-2930
Mailing Address - Fax:
Practice Address - Street 1:3886 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 202
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3835
Practice Address - Country:US
Practice Address - Phone:503-999-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical