Healthcare Provider Details

I. General information

NPI: 1104750546
Provider Name (Legal Business Name): BRANDON ALIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 SW 79TH AVE
TIGARD OR
97223-8735
US

IV. Provider business mailing address

11125 SW 79TH AVE
TIGARD OR
97223-8735
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-5137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number557129
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: