Individual provider Active NPI

Mackenzie Poisal, CSWA

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1477218543
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
A10281 Issued in OR
Practice address
5200 S Macadam Ave Ste 580
Portland, OR 97239-3837
Phone
(503) 231-7854
Fax
(503) 231-8153
NPI assigned
Nov 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X A10281 OR Primary

Addresses

Primary practice location

5200 S Macadam Ave Ste 580
Portland, OR 97239-3837

Mailing address

548 SE Lines St
Dallas, OR 97338-1960
Phone (503) 910-8817

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
A10281ORMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1477218543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 SE LINES ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381960",
            "telephone_number": "503-910-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 S MACADAM AVE STE 580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393837",
            "telephone_number": "503-231-7854",
            "fax_number": "503-231-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POISAL",
        "first_name": "MACKENZIE",
        "credential": "CSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "A10281",
            "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 Nov 3, 2021; 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.