1750720652 NPI number — ANNA BRITTANY DENNIS M.S., CGC

Table of content: ANNA BRITTANY DENNIS M.S., CGC (NPI 1750720652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750720652 NPI number — ANNA BRITTANY DENNIS M.S., CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNIS
Provider First Name:
ANNA
Provider Middle Name:
BRITTANY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CGC
Provider Gender Code:
F

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:
1750720652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 SW GAINES ST
Provider Second Line Business Mailing Address:
ROOM 3223
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-0431
Provider Business Mailing Address Fax Number:
503-494-9199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 SW GAINES ST
Provider Second Line Business Practice Location Address:
ROOM 3223
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-0431
Provider Business Practice Location Address Fax Number:
503-494-9199
Provider Enumeration Date:
06/24/2013

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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