Provider Demographics
NPI:1457903403
Name:PHADKULE, ANAGHA A (MC)
Entity type:Individual
Prefix:
First Name:ANAGHA
Middle Name:A
Last Name:PHADKULE
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17950 NW DEERCREEK CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3061
Mailing Address - Country:US
Mailing Address - Phone:480-334-3032
Mailing Address - Fax:
Practice Address - Street 1:17950 NW DEERCREEK CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3061
Practice Address - Country:US
Practice Address - Phone:480-334-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional