Provider Demographics
NPI:1316399801
Name:MCGEE, CLARISSA ANNE (THW)
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:ANNE
Last Name:MCGEE
Suffix:
Gender:F
Credentials:THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BROADWAY ST NE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1420
Mailing Address - Country:US
Mailing Address - Phone:503-302-9552
Mailing Address - Fax:503-390-3161
Practice Address - Street 1:1300 BROADWAY ST NE
Practice Address - Street 2:SUITE 403
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1420
Practice Address - Country:US
Practice Address - Phone:503-302-9552
Practice Address - Fax:503-390-3161
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW0780175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW0780Medicaid