Provider Demographics
NPI:1437682044
Name:RICE, DEBRA JANAE (PSS)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JANAE
Last Name:RICE
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:JANAE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1229 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4005
Mailing Address - Country:US
Mailing Address - Phone:503-409-5511
Mailing Address - Fax:
Practice Address - Street 1:2555 SILVERTON RD NE STE C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0837
Practice Address - Country:US
Practice Address - Phone:503-409-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW0000992175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW0000992OtherOHA OFFICE OF EQUITY AND INCLUSION TRADITIONAL HEALTH WORKER