1982055299 NPI number — DREW SILVERMAN MS, QMHP-C, CADC III

Table of content: DREW SILVERMAN MS, QMHP-C, CADC III (NPI 1982055299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982055299 NPI number — DREW SILVERMAN MS, QMHP-C, CADC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVERMAN
Provider First Name:
DREW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, QMHP-C, CADC III
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982055299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 NW 5TH ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97330-4849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-286-4010
Provider Business Mailing Address Fax Number:
541-286-4011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5055 NE ELLIOTT CIR
Provider Second Line Business Practice Location Address:
SUITE 80
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-9008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-286-0344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2016

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 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 05-11-90 , 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)





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