Christina L Cannon, RADT

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

63311 Jamison St
Bend, OR 97703-8288

Phone

(541) 332-7500

Fax

(541) 322-7565

NPI assigned

Jul 10, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Granite Wellness Centers

  • Community/Behavioral Health Agency
  • Grass Valley, CA
  • NPI 1750500237
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651622400000",
    "number": "1265084263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2577 NE COURTNEY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017752",
            "telephone_number": "541-332-7500",
            "fax_number": "541-322-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63311 JAMISON ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977038288",
            "telephone_number": "541-332-7500",
            "fax_number": "541-322-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "CHRISTINA",
        "middle_name": "L",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-10",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1353740719",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha Marie Canales, RN
• Vincent Paul Cancelliere
• Marcella R Canelo, REGISTERED DIETITIAN
• Stephanie M Canfield
• Sara Anne Cannalonga, M.S. CF-SLP
• Arthur S Cantor, M.D.
• Phuong Cao, D.O.
• Capacity Performance Therapy
• Bradley Howard Capp, MS, DC
• Sandra Lee Capp, D.C.

• Peer Specialist in Bend, OR
• Providers in Bend, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.