Healthcare Provider Details

I. General information

NPI: 1679483655
Provider Name (Legal Business Name): CHEYENNE CAMPBELL CADC
Entity Type: Individual
Gender: Female
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

4713 N ALBINA AVE STE 301
PORTLAND OR
97217-2605
US

IV. Provider business mailing address

4713 N ALBINA AVE STE 301
PORTLAND OR
97217-2605
US

V. Phone/Fax

Practice location:
  • Phone: 503-850-2474
  • Fax:
Mailing address:
  • Phone: 503-850-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: