Provider Demographics
NPI:1558989483
Name:GRACZYK, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:GRACZYK
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 1:511 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1830
Mailing Address - Country:US
Mailing Address - Phone:503-655-1029
Mailing Address - Fax:503-655-4705
Practice Address - Street 1:511 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1830
Practice Address - Country:US
Practice Address - Phone:503-655-1029
Practice Address - Fax:503-655-4705
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)