Provider Demographics
NPI:1336537943
Name:UJVARY, SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:UJVARY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NE SANDY BLVD
Mailing Address - Street 2:#208
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1881
Mailing Address - Country:US
Mailing Address - Phone:360-693-7349
Mailing Address - Fax:503-296-5758
Practice Address - Street 1:3800 NE SANDY BLVD
Practice Address - Street 2:#208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1881
Practice Address - Country:US
Practice Address - Phone:360-693-7349
Practice Address - Fax:503-296-5758
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR2557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health