Nicole Lavonne Altstadt, MSW, CSWA
Social Worker, Clinical in Gresham, OR. Individual provider (NPI-1).
NPI number1306507629
StatusActive
Last updated in NPPESJan 8, 2022
Details
- NPI
- 1306507629
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Nicole Lavonne Altstadt
- Credential
- MSW, CSWA
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 8, 2022
- Certification date
- Jan 8, 2022
- Last updated
- Jan 8, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | A5691 | OR | Yes |
Practice location
4295 Sw Tegart LnGresham, OR 97080-8653
Phone 503-545-9939
Mailing address
4295 Sw Tegart LnGresham, OR 97080-8653
Phone 503-545-9939
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