1225674922 NPI number — MS. SERENNA LYNN BEERS MS, CADC III, MAC

Table of content: (NPI 1336368158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225674922 NPI number — MS. SERENNA LYNN BEERS MS, CADC III, MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEERS
Provider First Name:
SERENNA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CADC III, MAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STONE
Provider Other First Name:
SERENNA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CADC III, MAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225674922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 N HOLLADAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEASIDE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97138-7131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-738-7700
Provider Business Mailing Address Fax Number:
503-738-7733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9026 BIPLANE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-860-9900
Provider Business Practice Location Address Fax Number:
916-817-1060
Provider Enumeration Date:
11/18/2019

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:  17-10-19 , 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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