MEDICARE: CHARLENE HARTLEY PSS-SUD

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		OR

General Provider Information

NPI Number	:	1790619989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE HARTLEY PSS-SUD

Provider Business Mailing Address
First Line	:	200 S LONGVIEW WAY APT 12
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1342
Country	:	US
Telephone Number	:	503-901-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S LONGVIEW WAY APT 12
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1342
Country	:	US
Telephone Number	:	503-901-4411
Fax Number	:

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ CHARLENE HARTLEY PSS-SUD” Practice Location

Language	Start Address	Practice Location

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