Basic Information
| Provider Information | |||||||||
| NPI: | 1568708626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | CAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 MEADOWS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970355277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712011720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 MEADOWS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970355277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712011720 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2012 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 372600000X | N | Nursing Service Related Providers | Adult Companion | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.