Provider Demographics
NPI:1851850069
Name:DUDZIAK, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DUDZIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3380
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:541-868-2003
Practice Address - Street 1:10011 SE DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1353
Practice Address - Country:US
Practice Address - Phone:503-928-3998
Practice Address - Fax:541-868-2003
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL71091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical