Provider Demographics
NPI:1528289428
Name:PRESTON, WYNNE ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:WYNNE
Middle Name:ELIZABETH
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0179
Mailing Address - Country:US
Mailing Address - Phone:503-325-5488
Mailing Address - Fax:503-325-4481
Practice Address - Street 1:#10 6TH STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-325-5488
Practice Address - Fax:503-325-4481
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL25241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical