Provider Demographics
NPI:1073237509
Name:ASHFORD, MARLON (CRM/PSS)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:ASHFORD
Suffix:
Gender:M
Credentials:CRM/PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-239-8407
Practice Address - Street 1:1427 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5008
Practice Address - Country:US
Practice Address - Phone:503-761-6006
Practice Address - Fax:503-761-1434
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-868175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22-CRM-868Medicaid