Healthcare Provider Details

I. General information

NPI: 1831706373
Provider Name (Legal Business Name): ELENA PLOCEK LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA PLOCEK CSWA

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

IV. Provider business mailing address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

V. Phone/Fax

Practice location:
  • Phone: 503-622-8964
  • Fax:
Mailing address:
  • Phone: 503-622-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA17730
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: