Organization
CREATE CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA WALTY LCSW (DIRECTOR)
(503) 842-7855
Entity
Organization
Contact information
Practice address
312 NW 10TH AVE, SUITE 200, PORTLAND, OR 97209-3121
(503) 842-7855
(503) 222-0984
Mailing address
312 NW 10TH AVE, SUITE 200, PORTLAND, OR 97209-3121
(503) 842-7855
(503) 222-0984
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2340
OR
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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