Provider Demographics
NPI:1497899421
Name:SNOW, ERIC REED
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:REED
Last Name:SNOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 SE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-9122
Mailing Address - Country:US
Mailing Address - Phone:503-788-3922
Mailing Address - Fax:503-788-3922
Practice Address - Street 1:9268 SE CLINTON ST
Practice Address - Street 2:2100 SE BELMONT
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1456
Practice Address - Country:US
Practice Address - Phone:503-872-0483
Practice Address - Fax:503-872-0481
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171M00000XOtherSKILLS TRAINER II