Individual
MARY JAYNE WYKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2415 SE 43RD AVE, PORTLAND, OR 97206-1600
(503) 872-0168
Mailing address
2935 NW 154TH AVE, BEAVERTON, OR 97006-5351
(503) 312-5181
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L4960
OR
Other
Enumeration date
10/02/2007
Last updated
07/26/2011
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