Healthcare Provider Details

I. General information

NPI: 1538878327
Provider Name (Legal Business Name): ANDREA VANESSA PASSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 SW CASCADE AVE STE 520
BEAVERTON OR
97008-7156
US

IV. Provider business mailing address

14322 SW WALNUT LN
TIGARD OR
97223-2093
US

V. Phone/Fax

Practice location:
  • Phone: 503-470-1100
  • Fax:
Mailing address:
  • Phone: 503-702-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: