Healthcare Provider Details

I. General information

NPI: 1033022686
Provider Name (Legal Business Name): GORDON JON ADDIS CADCI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 SE HAWTHORNE BLVD
PORTLAND OR
97214-5241
US

IV. Provider business mailing address

3228 SW BEAVERTON HILLSDALE HWY APT 17
PORTLAND OR
97239-1193
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-5250
  • Fax: 503-715-5672
Mailing address:
  • Phone: 503-719-5250
  • Fax: 503-715-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: