Provider Demographics
NPI:1417351586
Name:NOWICKIWEISS, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:NOWICKIWEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:NOWICKIWEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:805 SE 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2916
Mailing Address - Country:US
Mailing Address - Phone:971-271-7270
Mailing Address - Fax:971-302-6046
Practice Address - Street 1:805 SE 151ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2916
Practice Address - Country:US
Practice Address - Phone:971-271-7270
Practice Address - Fax:971-302-6046
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1245624253OtherORGANIZATION