Randall Princeton Brewster, CRM, PSS
Individual provider Active NPI Peer Specialist · Portland, OR
NPI 1295327245 · NPPES record last updated Feb 10, 2021
Key facts
- NPI
- 1295327245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 10564 SE Washington St
Portland, OR 97216-2809 - Phone
- (971) 325-6378
- NPI assigned
- Feb 10, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | OR | Yes |
Addresses
Primary practice location
10564 SE Washington St
Portland, OR 97216-2809
Mailing address
10564 SE Washington St
Portland, OR 97216-2809
Phone (971) 325-6378
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21-CRM-360 | Other | OR | MHACBO |
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.