Provider Demographics
NPI:1679083349
Name:MORRIS, VICKI RAE
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:RAE
Last Name:MORRIS
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 1:3585 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9468
Mailing Address - Country:US
Mailing Address - Phone:541-279-0978
Mailing Address - Fax:541-504-7552
Practice Address - Street 1:3585 SW 35TH ST.
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-279-0978
Practice Address - Fax:541-504-7552
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR526666253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency