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General NPI Number Information
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NPI Number | 1295889855
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Entity Type | Individual
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Provider Name | RENEE MARIE SELLMAN QMHA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 4101 NE DIVISION ST SUITE 100
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City | GRESHAM
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State | OR
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Zip | 97030-4617
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Country | US
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Telephone | 503-666-3808
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Fax | 503-666-6835
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Provider Business Mailing Address
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Address Line | 3824 SE 72ND AVE
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City | PORTLAND
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State | OR
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Zip | 97206-2514
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Country | US
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Telephone | 971-212-1248
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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