Provider Demographics
NPI:1295892073
Name:DIDIER, DONALD PATRICK (MSW)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:PATRICK
Last Name:DIDIER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SE WATER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2161
Mailing Address - Country:US
Mailing Address - Phone:503-233-6121
Mailing Address - Fax:503-233-6126
Practice Address - Street 1:604 SE WATER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2161
Practice Address - Country:US
Practice Address - Phone:503-233-6121
Practice Address - Fax:503-233-6126
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical