Individual provider Active NPI

Luci A Ladue, CADC II/QMHP-R

  • Addiction (Substance Use Disorder) Counselor
  • Gresham, OR
National Provider Identifier
1194046110
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
11-R-12 Issued in OR
Practice address
620 NE 2ND St
Gresham, OR 97030-7514
Phone
(971) 274-3757
Fax
(503) 912-5740
NPI assigned
Jun 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 24-QMHP-R-3281 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X 11-R-12 OR Primary

Addresses

Primary practice location

620 NE 2ND St
Gresham, OR 97030-7514

Mailing address

211 SE Caruthers St
Portland, OR 97214-4502
Phone (503) 224-1044

Other identifiers 2

IdentifierTypeStateIssuer
500641189MedicaidOR
500777183MedicaidOR

Other names 1

  • Luci A Ludlow Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11-R-12ORMDAddiction (Substance Use Disorder) Counselor
24-QMHP-R-3281ORMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1194046110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 SE CARUTHERS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144502",
            "telephone_number": "503-224-1044",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 NE 2ND ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307514",
            "telephone_number": "971-274-3757",
            "fax_number": "503-912-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LADUE",
        "first_name": "LUCI",
        "middle_name": "A",
        "credential": "CADC II/QMHP-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-14",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "24-QMHP-R-3281",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "11-R-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641189",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500777183",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LUCI",
            "last_name": "LUDLOW",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; 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.