Provider Demographics
NPI:1780793695
Name:HAMPEL, ROSALYN F (MED)
Entity type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:F
Last Name:HAMPEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:ROSALYN
Other - Middle Name:FAYE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:3550 N INTERSTATE AVE
Mailing Address - Street 2:KAISER PERMANENTE INTERSTATE MEDICAL OFFICE E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1043
Mailing Address - Country:US
Mailing Address - Phone:503-331-5294
Mailing Address - Fax:
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:KAISER PERMANENTE INTERSTATE MEDICAL OFFICE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1043
Practice Address - Country:US
Practice Address - Phone:503-331-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1625101YA0400X
CO570101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)