Individual provider · Type 1 NPI

Samuel Russell Waggoner

Addiction (Substance Use Disorder) Counselor · Portland, OR

NPI number 1316658974 Active

Practice location

2727 NE Flanders St
Portland, OR 97232-3159

Call (503) 238-5203 Map

Mailing address

2901 E Burnside St
Portland, OR 97214-1831

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XT-22-1492 (OR)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1316658974

Samuel Russell Waggoner's National Provider Identifier is 1316658974, issued on Dec 5, 2022. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Portland, OR. The record was last updated on Dec 5, 2022.