Provider Demographics
NPI:1083222913
Name:RAHN, ELISE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:RAHN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:MARIE
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1670 YEW ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2942
Mailing Address - Country:US
Mailing Address - Phone:951-514-9845
Mailing Address - Fax:
Practice Address - Street 1:1118 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4019
Practice Address - Country:US
Practice Address - Phone:503-585-4919
Practice Address - Fax:503-585-4965
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health