Individual
JOHN GREGORY SICKLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
511 SW 10TH AVE, SUITE 614, PORTLAND, OR 97205-2732
(503) 307-4112
Mailing address
10595 SW LUCAS CT, TUALATIN, OR 97062-8414
(503) 307-4112
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3493
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
10/25/2006
Last updated
01/18/2012
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