Healthcare Provider Details

I. General information

NPI: 1316310766
Provider Name (Legal Business Name): MRS. CASEY SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 SE POWELL BLVD
PORTLAND OR
97202-3371
US

IV. Provider business mailing address

PO BOX 1765
CORVALLIS OR
97339-1765
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-9591
  • Fax:
Mailing address:
  • Phone: 541-829-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: