Healthcare Provider Details

I. General information

NPI: 1164794731
Provider Name (Legal Business Name): RYAN PATRICK NEWTON MA, MFA, QMHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2012
Last Update Date: 01/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 NE KILLINGSWORTH ST
PORTLAND OR
97218-1404
US

IV. Provider business mailing address

4310 NE KILLINGSWORTH ST PO BOX 3007
PORTLAND OR
97218-1404
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-1181
  • Fax:
Mailing address:
  • Phone: 503-535-1181
  • Fax:

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: