Provider Demographics
NPI:1205925724
Name:POOL, MARILYN REEDY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:REEDY
Last Name:POOL
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 1:4511 SE HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3170
Mailing Address - Country:US
Mailing Address - Phone:503-232-6868
Mailing Address - Fax:503-232-8197
Practice Address - Street 1:4511 SE HAWTHORNE BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3170
Practice Address - Country:US
Practice Address - Phone:503-232-6868
Practice Address - Fax:503-232-8197
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118805Medicare ID - Type Unspecified