NPI 1306507629 · live from the CMS NPI Registry
Nicole Lavonne Altstadt, MSW, CSWA
Social Worker, Clinical in Gresham, OR. National Provider Identifier 1306507629, active.
NPI record
| NPI | 1306507629 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 4295 Sw Tegart Ln, Gresham, OR 97080 |
| Practice phone | 503-545-9939 |
| Enumerated | January 8, 2022 |
| Last updated | January 8, 2022 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker, Clinical primary | 1041C0700X | A5691 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.