Provider Demographics
NPI:1144017880
Name:DUCHESNEAU, TAYLOR EVAN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:EVAN
Last Name:DUCHESNEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 SE CARUTHERS ST APT 9
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5466
Mailing Address - Country:US
Mailing Address - Phone:971-341-5975
Mailing Address - Fax:
Practice Address - Street 1:6011 NE OREGON ST UNIT 212
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4300
Practice Address - Country:US
Practice Address - Phone:971-256-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty