Provider Demographics
NPI:1962186304
Name:HEWLETT, DAVID (MSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HEWLETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20145 SW TILE FLAT RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:528 COTTAGE ST NE STE 401
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3811
Practice Address - Country:US
Practice Address - Phone:503-583-8537
Practice Address - Fax:503-343-3331
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHP-R-2164101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500823728Medicaid