Amy L Bristow, CRM
Individual provider Active NPI Peer Specialist · Madras, OR
NPI 1659937852 · NPPES record last updated May 13, 2019
Key facts
- NPI
- 1659937852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- License
- 19-CRM-100 (OR)
- Practice address
- 125 SW C St
Madras, OR 97741-1458 - Phone
- (541) 306-4566
- Fax
- (541) 320-9005
- NPI assigned
- May 13, 2019
- Sex
- Female
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-CRM-100 | OR | MD | Peer Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 19-CRM-100 | OR | Yes |
Addresses
Primary practice location
125 SW C St
Madras, OR 97741-1458
Mailing address
125 SW C St
Madras, OR 97741-1458
Phone (541) 306-4566
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19-CRM-100 | Other | OR | CERTIFIED RECOVERY MENTOR |
Other providers in Madras, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2019. 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.