Provider Demographics
NPI:1699665695
Name:VANN, JOSHUA J (CADC-1)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:VANN
Suffix:
Gender:M
Credentials:CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 NW FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3406
Mailing Address - Country:US
Mailing Address - Phone:971-438-8793
Mailing Address - Fax:
Practice Address - Street 1:21440 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2024
Practice Address - Country:US
Practice Address - Phone:971-703-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-03-10657101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)