MEDICARE: ANN M STAPLE MA

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	:	1588194187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN M STAPLE MA

Provider Business Mailing Address
First Line	:	2905 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5068
Country	:	US
Telephone Number	:	503-781-5653
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212
Country	:	US
Telephone Number	:	503-781-5653
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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Directions to “ ANN M STAPLE MA” Practice Location

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