Provider Demographics
NPI:1720640923
Name:CALDWELL, BETH RENAH
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:RENAH
Last Name:CALDWELL
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 1:3517 SW WONDERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8574
Mailing Address - Country:US
Mailing Address - Phone:971-401-5816
Mailing Address - Fax:
Practice Address - Street 1:3517 SW WONDERVIEW AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8574
Practice Address - Country:US
Practice Address - Phone:971-401-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator