Provider Demographics
NPI:1881278505
Name:DELOGU-CLARK, RIVER CAROLE MARIE-JEANNE
Entity type:Individual
Prefix:
First Name:RIVER
Middle Name:CAROLE MARIE-JEANNE
Last Name:DELOGU-CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIVER
Other - Middle Name:CAROLE MARIE-JEANNE
Other - Last Name:DELOGU-CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11720 SE ALDER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3868
Mailing Address - Country:US
Mailing Address - Phone:503-383-1309
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5410
Practice Address - Country:US
Practice Address - Phone:503-427-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)