Provider Demographics
NPI:1205470978
Name:EMERY, CHANDRA (MSW, JD, LLM)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:EMERY
Suffix:
Gender:F
Credentials:MSW, JD, LLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 SW OSAGE ST UNIT 605
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1033
Mailing Address - Country:US
Mailing Address - Phone:503-806-6073
Mailing Address - Fax:
Practice Address - Street 1:921 SW WASHINGTON ST STE 420
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2836
Practice Address - Country:US
Practice Address - Phone:503-806-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA56561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical