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NPI Code Detail

MEDICARE: DEIRDRE KATHLEEN BENTLEY QMHP

MEDICARE:   DEIRDRE KATHLEEN BENTLEY  QMHP
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
1171M00000XCase Manager/Care Coordinator
2372600000XAdult Companion

General Provider Information

NPI Number : 1861547275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIRDRE KATHLEEN BENTLEY QMHP
Provider Business Mailing Address
First Line : 2714 SE 28TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1313
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 310 NW FLANDERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3941
Country : US
Telephone Number : 503-827-3949
Fax Number : 503-827-0931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 10/15/2010

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Directions to “ DEIRDRE KATHLEEN BENTLEY QMHP” Practice Location

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