Provider Demographics
NPI:1407635295
Name:BECKWITH, ANGELIA DENISE (CERTIFIED RECOVERY M)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:DENISE
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:CERTIFIED RECOVERY M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9856 MARION RD SE
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:OR
Mailing Address - Zip Code:97392-9789
Mailing Address - Country:US
Mailing Address - Phone:971-218-5141
Mailing Address - Fax:
Practice Address - Street 1:9856 MARION RD SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9789
Practice Address - Country:US
Practice Address - Phone:971-218-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-2348175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist