Provider Demographics
NPI:1568836708
Name:WALKER, GORDON VANCE JR (MSW, LCSW, CADC1)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:VANCE
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:MSW, LCSW, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3236
Mailing Address - Country:US
Mailing Address - Phone:503-875-3179
Mailing Address - Fax:503-639-9347
Practice Address - Street 1:2943 NE DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3236
Practice Address - Country:US
Practice Address - Phone:503-875-3179
Practice Address - Fax:503-639-9347
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR66131041C0700X
OR10-09-59101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)