Provider Demographics
NPI:1003428095
Name:WRIGHT, MARIAH SHAUNIKA RAY (CRM)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:SHAUNIKA RAY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0882
Mailing Address - Country:US
Mailing Address - Phone:541-429-8800
Mailing Address - Fax:541-429-8822
Practice Address - Street 1:715 SW DORION AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2070
Practice Address - Country:US
Practice Address - Phone:541-429-8800
Practice Address - Fax:541-429-8822
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-CRM-108175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20-CRM-180OtherMHACBO