Provider Demographics
NPI:1013616531
Name:PECH, CHARLENE ESTELLE (MS CJ, BA PSY)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ESTELLE
Last Name:PECH
Suffix:
Gender:F
Credentials:MS CJ, BA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SW OLD SHERIDAN RD APT B101
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6371
Mailing Address - Country:US
Mailing Address - Phone:503-560-5587
Mailing Address - Fax:
Practice Address - Street 1:1910 SW OLD SHERIDAN RD APT B101
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6371
Practice Address - Country:US
Practice Address - Phone:503-560-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator