Provider Demographics
NPI:1649881277
Name:ALLEN, MARJORIE GRACE
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:GRACE
Last Name:ALLEN
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 1:3276 NW CREST LOOP
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9628
Mailing Address - Country:US
Mailing Address - Phone:541-979-9842
Mailing Address - Fax:
Practice Address - Street 1:4105 SE INTERNATIONAL WAY STE 501
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-8855
Practice Address - Country:US
Practice Address - Phone:503-496-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator