Healthcare Provider Details

I. General information

NPI: 1659241230
Provider Name (Legal Business Name): REBECCA LYNN GOULET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA LYNN WAIBEL

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 N WERTH BLVD
NEWBERG OR
97132-7500
US

IV. Provider business mailing address

448 N WERTH BLVD
NEWBERG OR
97132-7500
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-2521
  • Fax: 503-554-3466
Mailing address:
  • Phone: 503-554-2521
  • Fax: 503-554-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: