1891461588 NPI number — ADRIENNE ERIN WILSON CLD, CPD, CCE, NCS

Table of content: ADRIENNE ERIN WILSON CLD, CPD, CCE, NCS (NPI 1891461588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891461588 NPI number — ADRIENNE ERIN WILSON CLD, CPD, CCE, NCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
ADRIENNE
Provider Middle Name:
ERIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CLD, CPD, CCE, NCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAWKINS
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891461588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69187 LARIAT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SISTERS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97759-9687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-462-0721
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1655 CAPITOL ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-7845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-877-2815
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2021

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: 374J00000X , with the licence number:  THW000105188 , 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)





Copyright © 2007-2024 www.npivalidator.com