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General NPI Number Information
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NPI Number | 1104708999
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Entity Type | Individual
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Provider Name | ANDREW SMITTLE CADC-R
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Gender | Male
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 925 COMMERCIAL ST SE STE 250
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City | SALEM
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State | OR
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Zip | 97302-4176
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Country | US
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Telephone | 503-304-4358
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Fax | 503-304-4361
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Provider Business Mailing Address
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Address Line | PO BOX 20674
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City | KEIZER
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State | OR
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Zip | 97307-0674
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Country | US
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Telephone | 503-304-4358
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Fax | 503-304-4361
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-25-5502
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License Number State | OR
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