Provider Demographics
NPI:1215672886
Name:POWELL, CYNTHIANNA RACHELLE
Entity type:Individual
Prefix:MRS
First Name:CYNTHIANNA
Middle Name:RACHELLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 SE HIGHWAY 212 UNIT L2
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9110
Mailing Address - Country:US
Mailing Address - Phone:971-346-1134
Mailing Address - Fax:
Practice Address - Street 1:10701 SE HIGHWAY 212 UNIT L2
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9110
Practice Address - Country:US
Practice Address - Phone:971-346-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach