Healthcare Provider Details

I. General information

NPI: 1508773540
Provider Name (Legal Business Name): AMANDA ELIZABETH IRWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NE JOHN OLSEN AVE STE 200
HILLSBORO OR
97124-5817
US

IV. Provider business mailing address

607 SE 15TH AVE
PORTLAND OR
97214-2604
US

V. Phone/Fax

Practice location:
  • Phone: 971-202-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18667
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA18667
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: