MEDICARE: ROSE MARIE AHART

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1154821676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE MARIE AHART

Provider Business Mailing Address
First Line	:	PO BOX 721
Second Line	:
City	:	AMITY
State	:	OR
Zip	:	97101-0721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 E THIRD ST
Second Line	:
City	:	AMITY
State	:	OR
Zip	:	97101-2248
Country	:	US
Telephone Number	:	971-237-4275
Fax Number	:

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “ ROSE MARIE AHART ” Practice Location

Language	Start Address	Practice Location

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