Healthcare Provider Details

I. General information

NPI: 1477477701
Provider Name (Legal Business Name): SUTAN GUTEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18410 SW DELINE ST
ALOHA OR
97078-3811
US

IV. Provider business mailing address

18410 SW DELINE ST
ALOHA OR
97078-3811
US

V. Phone/Fax

Practice location:
  • Phone: 503-267-6197
  • Fax:
Mailing address:
  • Phone: 503-267-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: