Provider Demographics
NPI:1649393661
Name:WAFER, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WAFER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:WAFER
Other - Last Name:GUKEISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8306 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5309
Mailing Address - Country:US
Mailing Address - Phone:541-784-6935
Mailing Address - Fax:541-229-2233
Practice Address - Street 1:8306 N EDISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5309
Practice Address - Country:US
Practice Address - Phone:541-784-6935
Practice Address - Fax:541-229-2233
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL11341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical