Organization
FIFTH CORNER ACADEMY
Active
Other names
Fifth Corner Community Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROXANNE FRANKLIN WILSON BA, QMHA, PSS (PRESIDENT/PROGRAM ADMINISTRATOR)
(503) 714-6306
Entity
Organization
Contact information
Practice address
1900 NE HIGHWAY 99W STE K, MCMINNVILLE, OR 97128-2757
(503) 472-4511
(503) 714-6306
Mailing address
650 NE 2ND ST UNIT 133, MCMINNVILLE, OR 97128-4762
(503) 472-4511
(503) 714-6306
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
163W00000X
Registered Nurse
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172A00000X
Driver
—
—
1744R1102X
Research Study Specialist
—
—
174H00000X
Health Educator
—
—
175T00000X
Peer Specialist
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851475099
—
OR
Enumeration date
10/30/2019
Last updated
03/28/2020
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