Provider Demographics
NPI:1447147657
Name:RUSSELL, JOSEPH TAYLOR (PWS, CRM, CADC-R)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TAYLOR
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PWS, CRM, CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SE MADISON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4527
Mailing Address - Country:US
Mailing Address - Phone:971-373-8170
Mailing Address - Fax:
Practice Address - Street 1:80 SE MADISON ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4527
Practice Address - Country:US
Practice Address - Phone:971-373-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1699550434Medicaid