Healthcare Provider Details

I. General information

NPI: 1285176883
Provider Name (Legal Business Name): SCOTT A VIGNOLA MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date: 08/21/2018
Reactivation Date: 03/15/2021

III. Provider practice location address

1020 SW TAYLOR ST STE 435
PORTLAND OR
97205-2509
US

IV. Provider business mailing address

1020 SW TAYLOR ST STE 435
PORTLAND OR
97205-2509
US

V. Phone/Fax

Practice location:
  • Phone: 503-449-3586
  • Fax:
Mailing address:
  • Phone: 503-449-3586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW.61332113
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL13880
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: