Individual provider Active NPI

Lisa Klavans-Rekosh, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1255864526
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L6432 Issued in OR
Practice address
30 NE MLK Blvd
Portland, OR 97232-2941
Phone
(503) 232-1099
NPI assigned
Apr 4, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L6432 OR Primary

Addresses

Primary practice location

30 NE MLK Blvd
Portland, OR 97232-2941

Mailing address

7226 N Mississippi Ave
Portland, OR 97217-1664
Phone (808) 280-7385

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L6432ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 21, 2022 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 20, 2022 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 20, 2022 Accepting new patients
Telecare Mental Health Services of Oregon, Inc. Past Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

3550 N Interstate Ave
Portland, OR 97227
Phone (503) 285-9321

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491264000000",
    "number": "1255864526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7226 N MISSISSIPPI AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171664",
            "telephone_number": "808-280-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 NE MLK BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322941",
            "telephone_number": "503-232-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLAVANS-REKOSH",
        "first_name": "LISA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-04",
        "last_updated": "2017-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.