Provider Demographics
NPI:1275131922
Name:ANDERSON, PARKER ELIZABETH-ROSE
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:ELIZABETH-ROSE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROSE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:418 BEAVERCREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4287
Mailing Address - Country:US
Mailing Address - Phone:971-203-0683
Mailing Address - Fax:503-212-0174
Practice Address - Street 1:418 BEAVERCREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4287
Practice Address - Country:US
Practice Address - Phone:971-203-0683
Practice Address - Fax:503-212-0174
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC10350101YP2500X
OR171M00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant