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1952931776
IRVIN D WILSON
PORTLAND, OR
NPI
1952931776
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: OR 20-11-14)
Enumeration Date
2020-01-21
Last Update Date
2022-06-29
Business Address
IRVIN D WILSON CADC I
17645 NW SAINT HELENS RD
PORTLAND, OR 97231-1729
Phone number: 503-621-1069
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Mailing Address
IRVIN D WILSON CADC I
1776 SW MADISON ST
PORTLAND, OR 97205-1715
Phone number: 503-224-1044
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