Individual
DONALD DAVID POLEVACIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.S.A.
Contact information
Practice address
5023 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1915
(503) 284-4249
(503) 284-6585
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/14/2012
Last updated
02/14/2012
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