Provider Demographics
NPI:1902217722
Name:CLEVENGER, WINDY
Entity Type:Individual
Prefix:MRS
First Name:WINDY
Middle Name:
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 NE EVANS ST STE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4635
Mailing Address - Country:US
Mailing Address - Phone:503-427-4020
Mailing Address - Fax:503-472-8630
Practice Address - Street 1:435 NE EVANS ST STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4635
Practice Address - Country:US
Practice Address - Phone:503-427-4020
Practice Address - Fax:503-472-8630
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist