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General NPI Number Information
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NPI Number | 1104193283
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Entity Type | Organization
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Legal Business Name | OUTSIDE IN
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 11300 SE 23RD AVENUE MILWAUKIE HIGH SCHOOL HEALTH & WELLNESS CENTER
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City | MILWAUKIE
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State | OR
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Zip | 97222-7753
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Country | US
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Telephone | 503-535-3861
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Fax | 503-223-6837
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Provider Business Mailing Address
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Address Line | 1132 SW 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97205-1703
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Country | US
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Telephone | 503-535-3861
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Fax | 503-223-6837
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HEATHER REPPETO
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Credential |
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Telephone | 503-535-3860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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