NPIMap

Organization Active NPI

Oregon Emdr LLC

  • Clinical Social Worker
  • Springfield, OR
National Provider Identifier
1699286591
Registry record updated Oct 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L5896 Issued in OR
Legal business name
OREGON EMDR LLC
Practice address
175 W B St
Springfield, OR 97477-4575
Phone
(541) 525-9416
Fax
(541) 722-7033
NPI assigned
Oct 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2017

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

Authorized official

Name
Susan Marie Wendelborg, LCSW
Title
Owner
Phone
(541) 525-9416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X L5896 OR Primary

Addresses

Primary practice location

175 W B St
Springfield, OR 97477-4575

Mailing address

1863 Pioneer Pkwy E
Springfield, OR 97477-3907

National Provider Directory

National Provider Directory

Locations

175 W B St
Springfield, OR 97477
Phone (541) 684-8166

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1699286591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1863 PIONEER PKWY E",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 W B ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774575",
            "telephone_number": "541-525-9416",
            "fax_number": "541-722-7033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON EMDR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "WENDELBORG",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-525-9416",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.