Provider Demographics
NPI:1073016663
Name:CLARE, REBECCA JANE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:CLARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 NE 61ST CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9359
Mailing Address - Country:US
Mailing Address - Phone:503-575-5545
Mailing Address - Fax:
Practice Address - Street 1:5240 NE ELAM YOUNG PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6210
Practice Address - Country:US
Practice Address - Phone:503-846-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-R-11101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)