Provider Demographics
NPI:1043668262
Name:JORDANA KRUEGER-TOSCHER, LCSW, LLC
Entity Type:Organization
Organization Name:JORDANA KRUEGER-TOSCHER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER-TOSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-277-2553
Mailing Address - Street 1:5816 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6130
Mailing Address - Country:US
Mailing Address - Phone:347-277-2553
Mailing Address - Fax:
Practice Address - Street 1:320 N MAIN AVE STE 201B
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7242
Practice Address - Country:US
Practice Address - Phone:971-270-0741
Practice Address - Fax:757-257-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL66071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty