MEDICARE: SHERRILYNN BLANTON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	97-04-08	OR
2	101YM0800X	Mental Health Counselor	A-2896	OR

General Provider Information

NPI Number	:	1104246909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRILYNN BLANTON

Provider Business Mailing Address
First Line	:	4134 N VANCOUVER AVE STE 102
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2900
Country	:	US
Telephone Number	:	503-331-2548
Fax Number	:	503-331-2549

Provider Business Practice Location Address
First Line	:	4134 N VANCOUVER AVE STE 102
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2900
Country	:	US
Telephone Number	:	503-331-2548
Fax Number	:	503-331-2549

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

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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Directions to “ SHERRILYNN BLANTON ” Practice Location

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