Provider Demographics
NPI:1164137394
Name:GWOZDZ, VINNIE (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:VINNIE
Middle Name:
Last Name:GWOZDZ
Suffix:
Gender:M
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17225 SE VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97267-6342
Mailing Address - Country:US
Mailing Address - Phone:503-380-8438
Mailing Address - Fax:
Practice Address - Street 1:17225 SE VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-6342
Practice Address - Country:US
Practice Address - Phone:503-380-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional