MEDICARE: CASSANDRA MARIE STURTZ

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1871808717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA MARIE STURTZ

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:	503-963-7711

Provider Business Practice Location Address
First Line	:	4005 AUMSVILLE HWY SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97317-9112
Country	:	US
Telephone Number	:	503-378-2144
Fax Number	:	503-378-2184

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

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	01/23/2014

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Directions to “ CASSANDRA MARIE STURTZ ” Practice Location

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