Nicole Lavonne Altstadt, MSW, CSWA
Individual provider Active NPI Clinical Social Worker · Gresham, OR
NPI 1306507629 · NPPES record last updated Jan 8, 2022
Key facts
- NPI
- 1306507629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- A5691 (OR)
- Practice address
- 4295 SW Tegart LN
Gresham, OR 97080-8653 - Phone
- (503) 545-9939
- NPI assigned
- Jan 8, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A5691 | OR | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | A5691 | OR | Yes |
Addresses
Primary practice location
4295 SW Tegart LN
Gresham, OR 97080-8653
Mailing address
4295 SW Tegart LN
Gresham, OR 97080-8653
Phone (503) 545-9939
Other providers in Gresham, OR
- Corbin Michael Allred
- Karen Yessenia Alonso-Granados
- Alta Ulrich, LMT LLC
- Alternative Sleep Health, Inc
- Doug R Altilio
- Frank Alvarez
- Britta Ameel
- Abreham Andualem Amera
- Amplife Chiropractic and Sports Chiropractic
- Joseph Jungho An
All providers in Gresham, OR · Clinical Social Worker in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.