Provider Demographics
NPI:1689884751
Name:PORTLAND HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PORTLAND HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STILWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-236-4506
Mailing Address - Street 1:1821 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1521
Mailing Address - Country:US
Mailing Address - Phone:503-236-4506
Mailing Address - Fax:503-236-4501
Practice Address - Street 1:1821 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1521
Practice Address - Country:US
Practice Address - Phone:503-236-4506
Practice Address - Fax:503-236-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1224715-1103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty