Healthcare Provider Details

I. General information

NPI: 1548790462
Provider Name (Legal Business Name): GARRETT ALAN NYMAN CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 NW CLEARWATER DR
BEND OR
97703-9469
US

IV. Provider business mailing address

2850 NE YELLOWPINE RD
PRINEVILLE OR
97754-8664
US

V. Phone/Fax

Practice location:
  • Phone: 541-355-4000
  • Fax:
Mailing address:
  • Phone: 541-788-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberA11674
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: