Provider Demographics
NPI:1609024041
Name:WAYMAN, NORA (LCSW)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:WAYMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 SW BUCKHORN PL
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-7535
Mailing Address - Country:US
Mailing Address - Phone:541-815-3102
Mailing Address - Fax:
Practice Address - Street 1:14275 SW BUCKHORN PL
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-7535
Practice Address - Country:US
Practice Address - Phone:541-815-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1631101YM0800X
ORL1631104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500617854Medicaid
ORR149641Medicare PIN