Healthcare Provider Details

I. General information

NPI: 1285597013
Provider Name (Legal Business Name): CASEY ANN EILERS LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 SW WATSON AVE # 355
BEAVERTON OR
97005-2132
US

IV. Provider business mailing address

4145 SW WATSON AVE # 355
BEAVERTON OR
97005-2132
US

V. Phone/Fax

Practice location:
  • Phone: 503-476-7307
  • Fax:
Mailing address:
  • Phone: 503-476-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number10261860
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: