MEDICARE: REBECCA CELESTE PAUST

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
1	101Y00000X	Counselor	C2762	OR

General Provider Information

NPI Number	:	1073977419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CELESTE PAUST

Provider Business Mailing Address
First Line	:	4305 SE COOPER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-7760
Country	:	US
Telephone Number	:	503-320-6313
Fax Number	:	503-722-4470

Provider Business Practice Location Address
First Line	:	4305 SE COOPER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-7760
Country	:	US
Telephone Number	:	503-320-6313
Fax Number	:	503-722-4470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/12/2016

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Directions to “ REBECCA CELESTE PAUST ” Practice Location

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