Individual provider Active NPI

Clifford Ray Dusky, CRM II, PWS, THW,

  • Peer Specialist
  • Gresham, OR
National Provider Identifier
1699615484
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
108990 Issued in OR
Practice address
355 NW Division St
Gresham, OR 97030-5523
Phone
(971) 217-9008
NPI assigned
Mar 31, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X 108990 OR Primary

Addresses

Primary practice location

355 NW Division St
Gresham, OR 97030-5523

Mailing address

211 SE Caruthers St
Portland, OR 97214-4502
Phone (971) 217-9008

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
108990ORMDPeer Specialist

NPI Registry JSON

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

{
    "created_epoch": "1774915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1699615484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 SE CARUTHERS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144502",
            "telephone_number": "971-217-9008",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 NW DIVISION ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305523",
            "telephone_number": "971-217-9008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUSKY",
        "first_name": "CLIFFORD",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "CRM II, PWS, THW,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-31",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "108990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; 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.