=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497614937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY DEMARCO-GREENHALGH THW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2026
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4263 COMMERCIAL ST SE
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97302-3995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-363-8068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3484 GLEN CREEK RD NW
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97304-2248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-849-5221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | 115833
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------