Healthcare Provider Details

I. General information

NPI: 1013908508
Provider Name (Legal Business Name): AAILEEN SUE CARMELL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 SW ALDER ST STE 300
PORTLAND OR
97205-3133
US

IV. Provider business mailing address

1776 SW MADISON ST
PORTLAND OR
97205-1715
US

V. Phone/Fax

Practice location:
  • Phone: 503-226-2203
  • Fax: 503-223-4231
Mailing address:
  • Phone: 503-621-1069
  • Fax: 503-621-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: