Healthcare Provider Details

I. General information

NPI: 1952219263
Provider Name (Legal Business Name): MARLIE MEHRTENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19536 SW STACEY ST
BEAVERTON OR
97003-2521
US

IV. Provider business mailing address

3126 STATE ST STE 100
MEDFORD OR
97504-8665
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-6003
  • Fax: 541-631-3424
Mailing address:
  • Phone: 458-225-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: