Basic Information
| Provider Information | |||||||||
| NPI: | 1841334794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3509 NW SAMARITAN DR | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973303766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417686412 | ||||||||
| FaxNumber: | 5417685201 | ||||||||
| Practice Location | |||||||||
| Address1: | 3509 NW SAMARITAN DR | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973303766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417686412 | ||||||||
| FaxNumber: | 5417685201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | L3184 | OR | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 233042 | 05 | OR | MEDICAID |