Individual
MRS. AMY L BRISTOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
125 SW C ST, MADRAS, OR 97741-1458
(541) 306-4566
(541) 320-9005
Mailing address
125 SW C ST, MADRAS, OR 97741-1458
(541) 306-4566
(541) 320-9005
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
19-CRM-100
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-CRM-100
CERTIFIED RECOVERY MENTOR
OR
Enumeration date
05/13/2019
Last updated
05/13/2019
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