Provider Demographics
NPI:1821212713
Name:MATHEWS, DEVON A (CADCII)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:A
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19345 ROBIN CIR
Mailing Address - Street 2:#84
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2386
Mailing Address - Country:US
Mailing Address - Phone:503-635-2088
Mailing Address - Fax:
Practice Address - Street 1:11945 SW PACIFIC HWY
Practice Address - Street 2:#113
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6469
Practice Address - Country:US
Practice Address - Phone:503-684-8159
Practice Address - Fax:503-598-0934
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR041158101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)