Active NPI
Rachel Petke, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1831749985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L3240
- Practice address
- 2800 N Vancouver Ave Ste 207
Portland, OR 97227-1630 - Phone
- (503) 276-9000
- Fax
- (503) 276-9010
- NPI assigned
- Sep 19, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 3240 | OR | |
| Clinical Social Worker | 1041C0700X | L3240 | OR | Primary |
Addresses
Primary practice location
2800 N Vancouver Ave Ste 207
Portland, OR 97227-1630
Mailing address
PO Box 4037
Portland, OR 97208-4037
Phone (503) 413-4048
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rpetke@lhs.org | Health Information Exchange (HIE) |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 3240 | OR | MD | Clinical Neuropsychologist |
| L3240 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1831749985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4037",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972084037",
"telephone_number": "503-413-4048",
"fax_number": "503-413-2910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 N VANCOUVER AVE STE 207",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271630",
"telephone_number": "503-276-9000",
"fax_number": "503-276-9010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETKE",
"first_name": "RACHEL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-19",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OR",
"license": "3240",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L3240",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rpetke@lhs.org",
"affiliation": "N",
"endpointDescription": "work email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "2800 N Vancouver Ave",
"city": "Portland",
"state": "OR",
"country_code": "US",
"postal_code": "972271630",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.