Healthcare Provider Details

I. General information

NPI: 1215410147
Provider Name (Legal Business Name): ASHLEY Y VANDE SLUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 SE 97TH AVE STE 340
CLACKAMAS OR
97015-7903
US

IV. Provider business mailing address

12901 SE 97TH AVE STE 340
CLACKAMAS OR
97015-7903
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8045
  • Fax: 503-655-6806
Mailing address:
  • Phone: 503-655-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

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: