MEDICARE: MS. DEBORAH NICOLETTE HALL CADC

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
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02-11-39	OTHER	OR	CADC

General Provider Information

NPI Number	:	1497891451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH NICOLETTE HALL CADC

Provider Business Mailing Address
First Line	:	2995 RYAN DR SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-5157
Country	:	US
Telephone Number	:	503-580-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 HAROLD DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1339
Country	:	US
Telephone Number	:	503-363-2021
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/14/2021

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