Provider Demographics
NPI:1659079002
Name:PRIES, MARCIE LYNN (CHW)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:LYNN
Last Name:PRIES
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:MS
Other - First Name:MARCIE
Other - Middle Name:LYNN
Other - Last Name:NOLLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 HAWTHORNE AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5378
Mailing Address - Country:US
Mailing Address - Phone:503-302-0104
Mailing Address - Fax:
Practice Address - Street 1:610 HAWTHORNE AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5378
Practice Address - Country:US
Practice Address - Phone:503-302-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000108269172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty