Healthcare Provider Details

I. General information

NPI: 1194278390
Provider Name (Legal Business Name): ABIGAIL J GRIFFITH MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030-3794
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-3439
  • Fax: 503-669-1360
Mailing address:
  • Phone: 503-661-3439
  • Fax: 503-669-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA3874
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL8036
License Number StateOR

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: