Provider Demographics
NPI:1053594564
Name:MANKOWSKI, JON EDWARD (MSW, DCSW)
Entity type:Individual
Prefix:PROF
First Name:JON
Middle Name:EDWARD
Last Name:MANKOWSKI
Suffix:
Gender:M
Credentials:MSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 NE 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1221
Mailing Address - Country:US
Mailing Address - Phone:503-706-7024
Mailing Address - Fax:
Practice Address - Street 1:2614 NE 44TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1221
Practice Address - Country:US
Practice Address - Phone:503-706-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS144171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical