Provider Demographics
NPI:1235509712
Name:WIANT, ALINA MARIE (QMHA)
Entity Type:Individual
Prefix:MS
First Name:ALINA
Middle Name:MARIE
Last Name:WIANT
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:MS
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:WIANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHA
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-238-0769
Mailing Address - Fax:
Practice Address - Street 1:847 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2684
Practice Address - Country:US
Practice Address - Phone:503-238-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR21557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator