Provider Demographics
NPI:1528579646
Name:NELSON-CAVIGLIA, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:NELSON-CAVIGLIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5415 SW WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2409
Mailing Address - Country:US
Mailing Address - Phone:503-645-3581
Mailing Address - Fax:
Practice Address - Street 1:1535 N WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1885
Practice Address - Country:US
Practice Address - Phone:503-238-2067
Practice Address - Fax:503-238-2004
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-CRM-130175T00000X
OR22QMHAI003519171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist