Healthcare Provider Details

I. General information

NPI: 1811888605
Provider Name (Legal Business Name): MICHAEL VANPOOL CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NE HOOD AVE STE 310
GRESHAM OR
97030-7324
US

IV. Provider business mailing address

5516 SE 142ND PL
PORTLAND OR
97236-2650
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-5288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA16185
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: