MEDICARE: DEBORAH LOUISE ALLISON QMHA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1790831147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH LOUISE ALLISON QMHA

Provider Business Mailing Address
First Line	:	1528 NE 63RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-4702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 SW 11TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2634
Country	:	US
Telephone Number	:	503-944-1205
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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