Provider Demographics
NPI:1134637655
Name:VANDERHOOF, JANUS K (CADC II)
Entity Type:Individual
Prefix:
First Name:JANUS
Middle Name:K
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:K
Other - Last Name:VANDERHOOF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC II
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:17645 NW SAINT HELENS RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97231-1729
Practice Address - Country:US
Practice Address - Phone:503-621-1069
Practice Address - Fax:503-621-0200
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-07-20089101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500738707Medicaid