Provider Demographics
NPI:1134970528
Name:SMITH, GARRETT AUSTIN (CRM)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 SE 125TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4908
Mailing Address - Country:US
Mailing Address - Phone:503-805-7268
Mailing Address - Fax:
Practice Address - Street 1:6828 SE HOLGATE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3504
Practice Address - Country:US
Practice Address - Phone:503-805-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-2920175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist