Provider Demographics
NPI:1386417335
Name:MCDANNELL, JOSHUA (CADC-R)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MCDANNELL
Suffix:
Gender:M
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21724 SE ALDER DR APT 3
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2449
Mailing Address - Country:US
Mailing Address - Phone:503-505-1577
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 122ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2081
Practice Address - Country:US
Practice Address - Phone:503-594-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-23-3223261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder