Provider Demographics
NPI:1568509578
Name:MANSFIELD, GERALD
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 N KILLINGSWORTH ST
Mailing Address - Street 2:#3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4562
Mailing Address - Country:US
Mailing Address - Phone:503-351-6297
Mailing Address - Fax:
Practice Address - Street 1:2375 NW GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3420
Practice Address - Country:US
Practice Address - Phone:503-243-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered372600000XNursing Service Related ProvidersAdult Companion