Individual provider Active NPI

Matthew David Niswander

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
National Provider Identifier
1174333272
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
T-25-5158 Issued in OR
Practice address
10564 SE Washington St
Portland, OR 97216-2809
Phone
(503) 228-9229
NPI assigned
Jan 10, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X 24-CRM-3982 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X T-25-5158 OR Primary

Addresses

Primary practice location

10564 SE Washington St
Portland, OR 97216-2809

Mailing address

19565 River Rd Apt 61
Gladstone, OR 97027-2229
Phone (503) 388-1203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
T-25-5158ORMDAddiction (Substance Use Disorder) Counselor
24-CRM-3982ORMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Volunteers of America Inc. CurrentSince Jan 12, 2025 Accepting new patients

Locations

10564 SE Washington St
Portland, OR 97216
Phone (503) 228-9229

Interoperability endpoints

  • Direct secure messaging: matthew.niswander.p1@direct.voaor.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1174333272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19565 RIVER RD APT 61",
            "city": "GLADSTONE",
            "state": "OR",
            "postal_code": "970272229",
            "telephone_number": "503-388-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10564 SE WASHINGTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162809",
            "telephone_number": "503-228-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISWANDER",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-10",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "24-CRM-3982",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T-25-5158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.