| Ebony Leree Shorts, LCSW | |
|
606 Medical Pkwy, Enterprise, OR 97828-5140 | |
| (541) 426-4524 | |
| (541) 426-3035 |
| Full Name | Ebony Leree Shorts |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 606 Medical Pkwy, Enterprise, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861274540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34010647A (Indiana) | Primary |
| 101Y00000X | Counselor | L15279 (Oregon) | Secondary |
| Entity Name | Lifespring Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1851489942 PECOS PAC ID: 5294624508 Enrollment ID: O20040805000332 |
| Mailing Address | Practice Location Address |
|---|---|
| Ebony Leree Shorts, LCSW 606 Medical Pkwy, Enterprise, OR 97828-5140 Ph: (541) 426-4524 | Ebony Leree Shorts, LCSW 606 Medical Pkwy, Enterprise, OR 97828-5140 Ph: (541) 426-4524 |
Jamie Rose Dickenson, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 603 Medical Pkwy, Enterprise, OR 97828 Phone: 208-870-9489 | |
Judith A. Wandschneider, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 207 Sw 1st St, Enterprise, OR 97828 Phone: 541-426-4524 Fax: 541-426-3035 | |
Mckayla Forsberg, Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 603 Medical Pkwy, Enterprise, OR 97828 Phone: 509-575-4084 |