Provider Demographics
NPI:1114662707
Name:LANGFORD, MALLORI J
Entity type:Individual
Prefix:
First Name:MALLORI
Middle Name:J
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16189 NW FESCUE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1656
Mailing Address - Country:US
Mailing Address - Phone:503-397-5211
Mailing Address - Fax:
Practice Address - Street 1:1306 NW HOYT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2731
Practice Address - Country:US
Practice Address - Phone:971-407-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator