MARISSA L ILLINGWORTH CRM PSS
NPI 1467152413
Peer Specialist in Salem, OR

Q: What is the provider's specialty?

The provider's specialty is Peer Specialist with taxonomy code 175T00000X.

Active since March 08, 2023

2045 SILVERTON RD NE, SALEM, OR 97301(503) 576-4660(503) 361-2688 Get Directions Write a Review

NPPES record last updated: July 17, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 17, 2024, Mar 8, 2023 (2 updates tracked since 2023).

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About Marissa L Illingworth Crm Pss NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARISSA L ILLINGWORTH CRM PSS (NPI 1467152413) is an individual peer specialist in Salem, Oregon, licensed in Oregon (22-CRM--1462) and active in the NPI registry since March 2023.

NPPES Registry Identity

NPI1467152413

Entity TypeIndividualFemale

Primary Taxonomy175T00000X

Provider Legal NameMARISSA L ILLINGWORTHCredential: CRM PSS

Location Address2045 SILVERTON RD NESalem, OR 97301-0100

Mailing Address5189 Dome Rock Ct SeSalem, OR 97306-2550 · (503) 851-6279

Phone(503) 576-4660

Fax(503) 361-2688

Sole ProprietorNo

Enumeration DateMarch 8, 2023

Last NPPES UpdateJuly 17, 20242 updates tracked since enumeration

NPPES CertifiedJuly 17, 2024

✔ NPI 1467152413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPeer SpecialistOther Service Providers

Taxonomy Code175T00000X

License✔ Licensed in OR · 22-CRM--1462

Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License T-23-2885 (OR)

2045 SILVERTON RD NE, Salem, OR 97301

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