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NPI Code Detail

MEDICARE: ROBERT JOHN CRIPPEN CADC 1

MEDICARE: ROBERT JOHN CRIPPEN CADC 1
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor09-P-07OR

General Provider Information

NPI Number : 1043522469
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT JOHN CRIPPEN CADC 1
Provider Business Mailing Address
First Line : 232 NW 6TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3609
Country : US
Telephone Number : 503-294-1681
Fax Number : 503-241-7419
Provider Business Practice Location Address
First Line : 726 W BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3515
Country : US
Telephone Number : 503-944-4410
Fax Number : 503-295-3777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 07/14/2010

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