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General NPI Number Information
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NPI Number | 1639353691
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Entity Type | Individual
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Provider Name | JULIE HASSEN WIESNER LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 423 NE 60TH AVE PORTLAND
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City | PORTLAND
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State | OR
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Zip | 97213-3725
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Country | US
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Telephone | 360-624-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 15520 NW 21ST AVE VANCOUVER
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City | VANCOUVER
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State | WA
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Zip | 98685-1251
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Country | US
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Telephone | 360-624-0800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L5073
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License Number State | OR
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