Provider Demographics
NPI:1811773344
Name:ZWALD, ANDREW RYAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:ZWALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14686 NW CORNELL RD APT 85
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5423
Mailing Address - Country:US
Mailing Address - Phone:541-418-1533
Mailing Address - Fax:
Practice Address - Street 1:1827 NE 44TH AVE STE 390
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1461
Practice Address - Country:US
Practice Address - Phone:503-963-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician