Healthcare Provider Details

I. General information

NPI: 1013055995
Provider Name (Legal Business Name): MARI KRESGE ALEXANDER PA-C, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARI ELIZABETH RILEY-KRESGE PA-C, LMFT

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SE 8TH AVE
HILLSBORO OR
97123-4218
US

IV. Provider business mailing address

PO BOX 568
CORNELIUS OR
97113-0568
US

V. Phone/Fax

Practice location:
  • Phone: 503-601-7400
  • Fax: 503-601-7311
Mailing address:
  • Phone: 503-352-8657
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0523
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01219
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: