NPIMap

Organization Active NPI

The Trauma Academy Northwest, LLC

  • Clinical Social Worker
  • Salem, OR
National Provider Identifier
1689100117
Registry record updated May 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L5774 Issued in OR
Legal business name
THE TRAUMA ACADEMY NORTHWEST, LLC
Practice address
2425 13TH St SE BLDG B
Salem, OR 97302-2545
Phone
(971) 301-2061
NPI assigned
May 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2017

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

Authorized official

Name
Mr. Abraham Reichlin, LCSW
Title
Owner
Phone
(503) 910-6395

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X L5774 OR Primary

Addresses

Primary practice location

2425 13TH St SE BLDG B
Salem, OR 97302-2545

Mailing address

2425 13TH St SE BLDG B
Salem, OR 97302-2545
Phone (971) 301-2061

National Provider Directory

National Provider Directory

Locations

2425 13th St SE
Bldg B
Salem, OR 97302
Phone (971) 301-2061

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1689100117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 13TH ST SE BLDG B",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022545",
            "telephone_number": "971-301-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 13TH ST SE BLDG B",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022545",
            "telephone_number": "971-301-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE TRAUMA ACADEMY NORTHWEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-03",
        "last_updated": "2017-05-03",
        "status": "A",
        "authorized_official_last_name": "REICHLIN",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-910-6395",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.