Healthcare Provider Details

I. General information

NPI: 1093649071
Provider Name (Legal Business Name): WILLGLOW PSYCHIATRY AND WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 SW SAGERT ST
TUALATIN OR
97062-6052
US

IV. Provider business mailing address

9301 SW SAGERT ST
TUALATIN OR
97062-6052
US

V. Phone/Fax

Practice location:
  • Phone: 503-486-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GLORIA WILLIAMS
Title or Position: OWNER
Credential: NP
Phone: 503-486-1740