Individual
MARISSA L ILLINGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM PSS
Contact information
Practice address
2045 SILVERTON RD NE, SALEM, OR 97301-0100
(503) 576-4660
(503) 361-2688
Mailing address
5189 DOME ROCK CT SE, SALEM, OR 97306-2550
(503) 851-6279
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-23-2885
OR
175T00000X
Peer Specialist
Primary
22-CRM--1462
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-23-2885
MHACBO
OR
Enumeration date
03/08/2023
Last updated
07/17/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us