Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Bulisco

Individual provider Peer Specialist · NPI 1073355798

Ethan Bulisco is a Peer Specialist in Portland, Oregon. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

5331 S Macadam Ave Ste 287
Portland, OR 97239-3849
Phone: (503) 635-3416
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X

Record details

NPI number1073355798
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 12, 2024
Last updated in NPPESJune 12, 2024
Certification dateJune 12, 2024
Mailing address5331 S Macadam Ave Ste 287, Portland, OR 97239-3849

Other providers in Portland