| West Linn Clementine, Inc | |
|
1148 Rosemont Rd West Linn OR 97068-9235 | |
| (971) 249-8448 | |
| (503) 305-7100 |
| Full Name | West Linn Clementine, Inc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1148 Rosemont Rd, West Linn, Oregon |
| Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3056631876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Linn Clementine, Inc 6100 Sw 76th St South Miami FL 33143-5002 Ph: (305) 663-1876 | West Linn Clementine, Inc 1148 Rosemont Rd West Linn OR 97068-9235 Ph: (971) 249-8448 |
| NPI Number | 1023562147 |
|---|---|
| Provider Enumeration Date | 08/05/2016 |
| Last Update Date | 03/04/2020 |
| Certification Date | 03/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023562147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (Oregon) | Primary |
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