| Andrea Mize Llc | |
|
10175 Sw Barbur Blvd Ste 300bg Portland OR 97219-5909 | |
| (503) 957-5947 | |
| (503) 206-0926 |
| Full Name | Andrea Mize Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10175 Sw Barbur Blvd Ste 300bg, Portland, Oregon |
| Authorized Official Name and Position | Andrea L Mize (OWNER) |
| Authorized Official Contact | 5039575947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea Mize Llc 3 Monroe Pkwy Ste P 242 Lake Oswego OR 97035-1486 Ph: (503) 957-5947 | Andrea Mize Llc 10175 Sw Barbur Blvd Ste 300bg Portland OR 97219-5909 Ph: (503) 957-5947 |
| NPI Number | 1124553797 |
|---|---|
| Provider Enumeration Date | 04/20/2017 |
| Last Update Date | 01/02/2019 |
| Medicare PECOS PAC ID | 1557604741 |
|---|---|
| Medicare Enrollment ID | O20190509001515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124553797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 7328 (Oregon) | Primary |
| Provider Name | Andrea L Mize |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043598659 PECOS PAC ID: 3173895943 Enrollment ID: I20170815002031 |
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