Jennifer Ludtke, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000018517 Issued in CA

Practice address

5210 N Kerby Ave
Portland, OR 97217-2699

Phone

(559) 707-1953

NPI assigned

Aug 11, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jenni Ludtke Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kingsburg Joint Union High School District

  • Local Education Agency (LEA)
  • Kingsburg, CA
  • NPI 1285447201
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1033528443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1739 NE 47TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132009",
            "telephone_number": "559-707-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5210 N KERBY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972172699",
            "telephone_number": "559-707-1953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11361 SW Leveton Dr",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "97062",
            "country_code": "US",
            "telephone_number": "559-707-1953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUDTKE",
        "first_name": "JENNIFER",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-11",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OR",
            "license": "AT-AT-10206431",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "2000018517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSURE",
            "identifier": "AT-AT-10206431",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNI",
            "last_name": "LUDTKE",
            "credential": "LAT, ATC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jackie Luckett
• Jesse Luckett, LMT
• Lucrecia V Suarez G LCSW PC
• Lynne Anne Ludeman, PMHNP
• Rachel Ludeman
• Emily Murray Ludwig, MSW, LCSW
• John Otto Louis Ludwig, MD
• Katya Hunt Ludwig, LCSW, SEP
• Rachel Ludwig
• Tristan James Ludwig

• Athletic Trainer in Portland, OR
• Providers in Portland, OR by specialty
• Athletic Trainer in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.