Provider Demographics
NPI:1497560510
Name:ROWLETT, MARK S (CADC 1/ CRM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:ROWLETT
Suffix:
Gender:M
Credentials:CADC 1/ CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 SE MILL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3974
Mailing Address - Country:US
Mailing Address - Phone:503-496-8465
Mailing Address - Fax:
Practice Address - Street 1:11930 SE MILL CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3974
Practice Address - Country:US
Practice Address - Phone:503-496-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-09-11240101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)