MEDICARE: MRS. ANNELISE SEVASTIANA SCHNASE M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1154678423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNELISE SEVASTIANA SCHNASE M.A.

Provider Business Mailing Address
First Line	:	15080 SE DEL REY AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-3310
Country	:	US
Telephone Number	:	503-521-6310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206
Country	:	US
Telephone Number	:	503-521-6310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	06/20/2014

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