Provider Demographics
NPI:1629116454
Name:SCOTT, WAYNE JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:JOSEPH
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NE 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4957
Mailing Address - Country:US
Mailing Address - Phone:503-988-6904
Mailing Address - Fax:503-988-4664
Practice Address - Street 1:1401 NE 68TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4957
Practice Address - Country:US
Practice Address - Phone:503-988-6904
Practice Address - Fax:503-988-4664
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL25321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical