1962681411 NPI number — DEANNA JUDITH ALLMARAS BA IN SOCIOLOGY

Table of content: DEANNA JUDITH ALLMARAS BA IN SOCIOLOGY (NPI 1962681411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962681411 NPI number — DEANNA JUDITH ALLMARAS BA IN SOCIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLMARAS
Provider First Name:
DEANNA
Provider Middle Name:
JUDITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA IN SOCIOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOD
Provider Other First Name:
DEANNA
Provider Other Middle Name:
JUDITH
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:
1962681411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8834 NE THOMPSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97220-5473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-255-4560
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3906 SW KELLY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-320-6996
Provider Business Practice Location Address Fax Number:
503-327-8696
Provider Enumeration Date:
11/01/2007

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: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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