Provider Demographics
NPI:1467003368
Name:EZZEDDINE, NADEEN
Entity Type:Individual
Prefix:
First Name:NADEEN
Middle Name:
Last Name:EZZEDDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 SW MULTNOMAH BLVD APT 28
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3773
Mailing Address - Country:US
Mailing Address - Phone:714-350-6570
Mailing Address - Fax:
Practice Address - Street 1:4445 SW BARBUR BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4047
Practice Address - Country:US
Practice Address - Phone:503-686-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)