Provider Demographics
NPI:1902404676
Name:GUERTIN, CANDICE MARIE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:GUERTIN
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 1:1975 NW 167TH PL STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4908
Mailing Address - Country:US
Mailing Address - Phone:971-326-9644
Mailing Address - Fax:
Practice Address - Street 1:1975 NW 167TH PL STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4908
Practice Address - Country:US
Practice Address - Phone:971-326-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor