Individual
MATTHEW DAVID NISWANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 228-9229
Mailing address
19565 RIVER RD APT 61, GLADSTONE, OR 97027-2229
(503) 388-1203
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-25-5158
OR
175T00000X
Peer Specialist
24-CRM-3982
OR
Other
Enumeration date
01/10/2025
Last updated
06/24/2025
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