Healthcare Provider Details

I. General information

NPI: 1215727441
Provider Name (Legal Business Name): LAURA GORDON CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9860 SW HALL BLVD STE B
TIGARD OR
97223-8896
US

IV. Provider business mailing address

1933 SE ALDER ST
PORTLAND OR
97214-2724
US

V. Phone/Fax

Practice location:
  • Phone: 971-204-6426
  • Fax:
Mailing address:
  • Phone: 860-810-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA16372
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: