Provider Demographics
NPI:1508429382
Name:ALLEN, CHELSEY A (THW/PSS)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:THW/PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3042
Mailing Address - Country:US
Mailing Address - Phone:541-248-2773
Mailing Address - Fax:541-272-3740
Practice Address - Street 1:137 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3042
Practice Address - Country:US
Practice Address - Phone:541-248-2773
Practice Address - Fax:541-272-3740
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8851050172A00000X
172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker