Provider Demographics
NPI:1679861652
Name:BAUER, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 SE FOSTER RD
Mailing Address - Street 2:PO BOX 86101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97286-5442
Mailing Address - Country:US
Mailing Address - Phone:541-638-0830
Mailing Address - Fax:
Practice Address - Street 1:8196 SW HALL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6401
Practice Address - Country:US
Practice Address - Phone:541-638-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORC5743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)