Provider Demographics
NPI:1811418353
Name:SERVELLON-MARENCO, VANESSA ABIGAIL (MSW, QHMP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ABIGAIL
Last Name:SERVELLON-MARENCO
Suffix:
Gender:F
Credentials:MSW, QHMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BEAVERCREEK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4302
Mailing Address - Country:US
Mailing Address - Phone:503-655-8401
Mailing Address - Fax:503-655-8429
Practice Address - Street 1:150 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4302
Practice Address - Country:US
Practice Address - Phone:503-645-3581
Practice Address - Fax:503-609-9605
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY