Provider Demographics
NPI:1124017199
Name:ST CLAIR, KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ST CLAIR
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:PO BOX 42463
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97242-0463
Mailing Address - Country:US
Mailing Address - Phone:503-407-0421
Mailing Address - Fax:503-235-5396
Practice Address - Street 1:2625 SE HAWTHORNE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2941
Practice Address - Country:US
Practice Address - Phone:503-407-0421
Practice Address - Fax:503-235-5396
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL21971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR148851OtherMEDICARE PTAN
OR500604645Medicaid