Provider Demographics
NPI:1760897102
Name:WIENHOLZ, BRITTANY R (LCSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:R
Last Name:WIENHOLZ
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 1:3939 NE HANCOCK ST.
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212
Mailing Address - Country:US
Mailing Address - Phone:971-940-6729
Mailing Address - Fax:503-200-1105
Practice Address - Street 1:3939 NE HANCOCK ST.
Practice Address - Street 2:SUITE 211
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212
Practice Address - Country:US
Practice Address - Phone:971-940-6729
Practice Address - Fax:503-200-1105
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
OR7327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500679023Medicaid