Healthcare Provider Details

I. General information

NPI: 1225459548
Provider Name (Legal Business Name): NORTHWEST ADHD TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2014
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 SE DIVISION ST SUITE 203
PORTLAND OR
97266-1351
US

IV. Provider business mailing address

PO BOX 16308
PORTLAND OR
97292-0308
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-2343
  • Fax: 503-255-2344
Mailing address:
  • Phone: 971-231-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2197
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201150043NP
License Number StateOR

VIII. Authorized Official

Name: DANELL BJORNSON
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 971-533-4184