Provider Demographics
NPI:1992248769
Name:MANWARING, ROCHELLE ANIK
Entity type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:ANIK
Last Name:MANWARING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:ANIK
Other - Last Name:MANWARING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-0278
Mailing Address - Country:US
Mailing Address - Phone:971-983-5260
Mailing Address - Fax:971-983-5326
Practice Address - Street 1:825 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6715
Practice Address - Country:US
Practice Address - Phone:541-779-5228
Practice Address - Fax:541-772-1533
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL65911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL6591OtherOREGON STATE BOARD OF LICENSED SOCIAL WORKERS