Individual ProviderAlyssa J DistorSocial WorkerBehavioral Health & Social Service ProvidersPractice Address2020 SE Powell Blvd, Portland, OR 97202-2345(310) 259-9136PECOS EnrollmentBased on the most recent information from CMS, provider Alyssa J Distor does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1003479296Provider TypeIndividualFull NameDistor, Alyssa JGenderFemaleSole ProprietorNoEnumeration Date4/15/2019Last Updated4/15/2019Contact InformationPractice LocationPractice Address2020 SE Powell Blvd, Portland, OR 97202-2345Phone(310) 259-9136FaxUnlisted FaxMailing LocationMailing Address2020 SE Powell Blvd, Portland, OR 97202-2345PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID54023227DescriptionOtherIssuerKAISER PERMANENTEOregon