Provider Demographics
NPI:1699029991
Name:WOLF, MORGANNA WYNTER (MSW, CSWA, CADCI)
Entity Type:Individual
Prefix:
First Name:MORGANNA
Middle Name:WYNTER
Last Name:WOLF
Suffix:
Gender:F
Credentials:MSW, CSWA, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SW 141ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2382
Mailing Address - Country:US
Mailing Address - Phone:503-941-3033
Mailing Address - Fax:503-941-3034
Practice Address - Street 1:17175 SW TV HWY
Practice Address - Street 2:SUITE B2
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-4584
Practice Address - Country:US
Practice Address - Phone:503-941-3063
Practice Address - Fax:503-941-3099
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-11-71U3101YA0400X
ORL58561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)