1033672613 NPI number — GABRIELLE M MEESE CADC-R

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033672613 NPI number — GABRIELLE M MEESE CADC-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEESE
Provider First Name:
GABRIELLE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEESE
Provider Other First Name:
GABRIELLE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CADC-R
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033672613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 SW C ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADRAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97741-1458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-306-4566
Provider Business Mailing Address Fax Number:
541-320-9005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 SW C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADRAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97741-1458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-306-4566
Provider Business Practice Location Address Fax Number:
541-320-9005
Provider Enumeration Date:
04/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  82-1905562 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: T-19-184 . This is a "MHACCBO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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