Provider Demographics
NPI:1043239767
Name:LADENDORFF, LISA L (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:LADENDORFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2733
Mailing Address - Country:US
Mailing Address - Phone:541-805-5502
Mailing Address - Fax:541-963-5272
Practice Address - Street 1:105 FIR ST
Practice Address - Street 2:SUITE 332
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2661
Practice Address - Country:US
Practice Address - Phone:541-805-5502
Practice Address - Fax:541-963-5272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
ORL23261041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional