MEDICARE: ANGELIA DENISE BECKWITH CERTIFIED RECOVERY M

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	175T00000X	Peer Specialist	23-CRM-2348	OR

General Provider Information

NPI Number	:	1407635295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIA DENISE BECKWITH CERTIFIED RECOVERY M

Provider Business Mailing Address
First Line	:	9856 MARION RD SE
Second Line	:
City	:	TURNER
State	:	OR
Zip	:	97392-9789
Country	:	US
Telephone Number	:	971-218-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	9856 MARION RD SE
Second Line	:
City	:	TURNER
State	:	OR
Zip	:	97392-9789
Country	:	US
Telephone Number	:	971-218-5141
Fax Number	:

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

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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Directions to “ ANGELIA DENISE BECKWITH CERTIFIED RECOVERY M” Practice Location

Language	Start Address	Practice Location

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