Provider Demographics
NPI:1073221792
Name:BENNETT, DEBRA LEE (CRM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:BENNETT
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 1:750 FRONT ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1089
Mailing Address - Country:US
Mailing Address - Phone:971-332-7211
Mailing Address - Fax:
Practice Address - Street 1:750 FRONT ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1089
Practice Address - Country:US
Practice Address - Phone:971-332-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist