Provider Demographics
NPI:1598208811
Name:PEARSON, NANCY ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SE MARION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7033
Mailing Address - Country:US
Mailing Address - Phone:503-543-3969
Mailing Address - Fax:
Practice Address - Street 1:1005 SE MARION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7033
Practice Address - Country:US
Practice Address - Phone:503-543-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-19
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical