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RANDY BRETT WILSON
NPI 1720976434
Peer Specialist in Portland, OR

Active since June 24, 2025
3036 NE MLK JR BLVD, PORTLAND, OR 97212(503) 283-3763 Get Directions Write a Review

NPPES record last updated: June 24, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Randy Brett Wilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RANDY BRETT WILSON (NPI 1720976434) is an individual peer specialist in Portland, Oregon and active in the NPI registry since June 2025.

NPPES Registry Identity

NPI1720976434
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameRANDY BRETT WILSON
Location Address3036 NE MLK JR BLVDPortland, OR 97212-3053
Mailing AddressPo Box 8459Portland, OR 97207-8459
Phone(503) 283-3763
Sole ProprietorNo
Enumeration DateJune 24, 2025
NPPES CertifiedJune 24, 2025
✔ NPI 1720976434 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
3036 NE MLK JR BLVD, Portland, OR 97212
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASHLEY BARDALES
Peer Specialist
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763
JENIFER PREVOST
Peer Specialist
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763
ANNDREA GLADYS VAUGHN
Case Manager/Care Coordinator
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 889-2500
JESSICA SHIRLEY CUSHMAN
Case Manager/Care Coordinator
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763
MS. JUNIPER ELIZABETH WAGNER
Counselor (Mental Health)
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763
BENJAMIN MICHAEL DAVIDSON
Student in an Organized Health Care Education/Training Program
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763
MADELEINE ROSE POTTER PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763
PHILIP JOHN MAGGI
Counselor (Addiction (Substance Use Disorder))
3036 NE MLK JR BLVD
PORTLAND, OR 97212
Multnomah County (503) 283-3763

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Randy Wilson's NPI number?

The NPI number for Randy Wilson is 1720976434. It was assigned to this individual provider in the NPPES registry on June 24, 2025.

Where is Randy Wilson located?

Randy Wilson practices at 3036 NE Mlk Jr Blvd, Portland, OR 97212. The listed phone number is (503) 283-3763.

What is Randy Wilson's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Randy Wilson was last updated on June 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.