Provider Demographics
NPI:1356973945
Name:FARKAC, AILENE JOYCE (MSW, PSS)
Entity type:Individual
Prefix:
First Name:AILENE
Middle Name:JOYCE
Last Name:FARKAC
Suffix:
Gender:F
Credentials:MSW, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17155 SW BLANTON ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1829
Mailing Address - Country:US
Mailing Address - Phone:541-255-9897
Mailing Address - Fax:
Practice Address - Street 1:3311 NE MARTIN LUTHER KING JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2086
Practice Address - Country:US
Practice Address - Phone:503-206-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker