Marissa L Illingworth, CRM PSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

22-CRM--1462 Issued in OR

Practice address

2045 Silverton Rd NE
Salem, OR 97301-0100

Phone

(503) 576-4660

Fax

(503) 361-2688

NPI assigned

Mar 8, 2023

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Marion County

  dba Marion County Health and Human Services

  • Methadone Clinic
  • Salem, OR
  • NPI 1386706919
  NPD
• Marion County

  dba Marion County Health Department

  • Adult Mental Health Clinic/Center
  • Salem, OR
  • NPI 1528147782
  NPD (past)

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1467152413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5189 DOME ROCK CT SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973062550",
            "telephone_number": "503-851-6279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 SILVERTON RD NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973010100",
            "telephone_number": "503-576-4660",
            "fax_number": "503-361-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLINGWORTH",
        "first_name": "MARISSA",
        "middle_name": "L",
        "credential": "CRM PSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-08",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T-23-2885",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "22-CRM--1462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHACBO",
            "identifier": "T-23-2885",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muhammad Taimoor Iftikhar, MBBS
• Rayna Ashley Kahealani Ignacio Mac Guyer
• Igor Sitnik DMD, PC
• Rebekkah Anne Igou, CADC I
• Matthew Yoshio Iguchi, PHARM.D.
• Impact Behavioral Health LLC
• Independent Anywhere LLC
• Infocus Counseling Services
• Susanne Ingels, N.P.
• Robert Maurice Ingle Jr., M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.