Healthcare Provider Details

I. General information

NPI: 1659039527
Provider Name (Legal Business Name): AILEEN S O'HOGAN CRM, CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 LIBERTY ST SE
SALEM OR
97302-4143
US

IV. Provider business mailing address

1160 LIBERTY ST SE
SALEM OR
97302-4143
US

V. Phone/Fax

Practice location:
  • Phone: 503-751-2564
  • Fax:
Mailing address:
  • Phone: 503-751-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26-06-11945
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number21-CRM-749
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: