Provider Demographics
NPI:1588936140
Name:PRITCHETT, DON
Entity type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:PRITCHETT
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 1:4417 SE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3637
Mailing Address - Country:US
Mailing Address - Phone:303-809-4120
Mailing Address - Fax:
Practice Address - Street 1:4417 SE 31ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3637
Practice Address - Country:US
Practice Address - Phone:303-809-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-29
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator