Provider Demographics
NPI:1679554000
Name:TERRY, LINDA M (MSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:TERRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-0803
Mailing Address - Country:US
Mailing Address - Phone:541-567-3394
Mailing Address - Fax:541-567-3394
Practice Address - Street 1:405 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1843
Practice Address - Country:US
Practice Address - Phone:541-567-3394
Practice Address - Fax:541-567-3394
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL19201041C0700X
WALW000043431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130283Medicare ID - Type UnspecifiedMENTAL HEALTH