Jennifer Ludtke, ATC
Specialist/Technologist, Athletic Trainer in Portland, OR. Individual provider (NPI-1).
NPI number1033528443
StatusActive
Last updated in NPPESJan 24, 2022
Details
- NPI
- 1033528443
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Ludtke
- Credential
- ATC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 11, 2014
- Certification date
- Jan 18, 2022
- Last updated
- Jan 24, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2000018517 | CA | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT-AT-10206431 | OR |
Other names
- Jenni Ludtke (Professional Name)
Practice location
5210 N Kerby AvePortland, OR 97217-2699
Phone 559-707-1953
Mailing address
1739 Ne 47th AvePortland, OR 97213-2009
Phone 559-707-1953
Other practice locations
11361 Sw Leveton Dr
Tualatin, OR 97062
Tualatin, OR 97062
Phone 559-707-1953
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