Healthcare Provider Details

I. General information

NPI: 1134254287
Provider Name (Legal Business Name): HANS RICHARD WOICKE M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NE ALBERTA ST
PORTLAND OR
97211-5803
US

IV. Provider business mailing address

4911 NE 36TH AVE
PORTLAND OR
97211-7621
US

V. Phone/Fax

Practice location:
  • Phone: 503-367-9611
  • Fax:
Mailing address:
  • Phone: 503-367-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11355
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: