Healthcare Provider Details

I. General information

NPI: 1588501597
Provider Name (Legal Business Name): PHOEBE SECOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 SW KALAMA AVE BLDG B
REDMOND OR
97756-3054
US

IV. Provider business mailing address

1314 SW KALAMA AVE BLDG B
REDMOND OR
97756-3054
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-4876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number545800
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: