Provider Demographics
NPI:1205968526
Name:SWIERCINSKY, DENNIS P (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:SWIERCINSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-1726
Mailing Address - Country:US
Mailing Address - Phone:503-450-0599
Mailing Address - Fax:
Practice Address - Street 1:1001 SW 5TH AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1147
Practice Address - Country:US
Practice Address - Phone:503-450-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1532103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist