Provider Demographics
NPI:1114246683
Name:MAHNKE, ALLISON JEAN (LDM, CPM,)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:JEAN
Last Name:MAHNKE
Suffix:
Gender:F
Credentials:LDM, CPM,
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JEAN
Other - Last Name:CASLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9318 N WOOLSEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2029
Mailing Address - Country:US
Mailing Address - Phone:541-321-9505
Mailing Address - Fax:
Practice Address - Street 1:9318 N WOOLSEY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2029
Practice Address - Country:US
Practice Address - Phone:541-321-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000107887374J00000X
ORDEMLD10136025176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula