Provider Demographics
NPI:1194260927
Name:FORWARDSTRIDE
Entity type:Organization
Organization Name:FORWARDSTRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-590-2959
Mailing Address - Street 1:18218 SW HORSE TALE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9789
Mailing Address - Country:US
Mailing Address - Phone:503-590-2959
Mailing Address - Fax:503-590-2969
Practice Address - Street 1:18218 SW HORSE TALE DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9789
Practice Address - Country:US
Practice Address - Phone:503-590-2959
Practice Address - Fax:503-590-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR579722405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty