Healthcare Provider Details

I. General information

NPI: 1588701387
Provider Name (Legal Business Name): GREGORY JOHN JUDKINS CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE 7TH ST
GRESHAM OR
97030-5604
US

IV. Provider business mailing address

3215 NE 40TH AVE
PORTLAND OR
97212-2813
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-2213
  • Fax: 503-661-4959
Mailing address:
  • Phone: 503-288-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number97-10-34
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: