Organization
OREGON SCOTTISH RITE CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILL LEVINSON PHD SLP (EXECUTIVE DIRECTOR)
(503) 226-1048
Entity
Organization
Contact information
Practice address
5125 SW MACADAM AVE, SUITE 200, PORTLAND, OR 97239-3809
(503) 226-1048
Mailing address
4201 NE 80TH AVE, PORTLAND, OR 97218-4211
(503) 282-2412
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
235Z00000X
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247347
—
OR
01
—
838353006
BLUECROSS
OR
Enumeration date
01/30/2007
Last updated
03/24/2009
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