Provider Demographics
NPI:1285176883
Name:VIGNOLA, SCOTT A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:VIGNOLA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SW TAYLOR ST STE 435
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2509
Mailing Address - Country:US
Mailing Address - Phone:503-449-3586
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST STE 435
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2509
Practice Address - Country:US
Practice Address - Phone:503-449-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2025-01-13
Deactivation Date:2018-08-21
Deactivation Code:
Reactivation Date:2021-03-15
Provider Licenses
StateLicense IDTaxonomies
WALW.613321131041C0700X
ORL138801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical