Create Change, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2340 Issued in OR

Legal business name

CREATE CHANGE, LLC

Practice address

312 NW 10TH Ave
Suite 200
Portland, OR 97209-3121

Phone

(503) 842-7855

Fax

(503) 222-0984

NPI assigned

Apr 11, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sheila Walty, LCSW

Title

Director

Phone

(503) 842-7855

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1407210867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 NW 10TH AVE",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093121",
            "telephone_number": "503-842-7855",
            "fax_number": "503-222-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 NW 10TH AVE",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093121",
            "telephone_number": "503-842-7855",
            "fax_number": "503-222-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATE CHANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-11",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "WALTY",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "503-842-7855",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "2340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Nicole Crea, LPC
• John Robert Creager, DMD
• Geanna Creamer
• Marissa Dawn Creamer, LMT
• John Matthew Creasy, MD
• Creative Communications, LLC
• Creative Play and Speech Therapy, Inc
• Creative Therapy Connections, LLC
• Creative Therapy for the Heart, LLC
• Creative Thriving, LLC

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.