Healthcare Provider Details

I. General information

NPI: 1275480683
Provider Name (Legal Business Name): MICHAEL AARON HALISKI MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17600 PACIFIC HWY
MARYLHURST OR
97036-8002
US

IV. Provider business mailing address

17600 PACIFIC HWY
MARYLHURST OR
97036-8002
US

V. Phone/Fax

Practice location:
  • Phone: 503-675-2374
  • Fax: 503-675-2380
Mailing address:
  • Phone: 503-675-2374
  • Fax: 503-675-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberL4557
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: