Healthcare Provider Details

I. General information

NPI: 1295889855
Provider Name (Legal Business Name): RENEE MARIE SELLMAN QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST SUITE 100
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

3824 SE 72ND AVE
PORTLAND OR
97206-2514
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-3808
  • Fax: 503-666-6835
Mailing address:
  • Phone: 971-212-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: