Healthcare Provider Details

I. General information

NPI: 1003726084
Provider Name (Legal Business Name): ASHLYN REEVES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 N WILLIAMS AVE
PORTLAND OR
97227-1885
US

IV. Provider business mailing address

121 NW EVERETT ST
PORTLAND OR
97209-4049
US

V. Phone/Fax

Practice location:
  • Phone: 503-238-2067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-5049
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: