Provider Demographics
NPI:1326185562
Name:SPEAR, VICKY LYNN (MA CADCII)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:LYNN
Last Name:SPEAR
Suffix:
Gender:F
Credentials:MA CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 SE MCLOUGHLIN BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7428
Mailing Address - Country:US
Mailing Address - Phone:855-770-0577
Mailing Address - Fax:503-654-1852
Practice Address - Street 1:24499 SW GRAHAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7523
Practice Address - Country:US
Practice Address - Phone:503-570-6568
Practice Address - Fax:503-570-6554
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR05-03-64U101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health