Provider Demographics
NPI:1124419585
Name:KATIE JANE ROEDA, MSW, LCSW
Entity Type:Organization
Organization Name:KATIE JANE ROEDA, MSW, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:503-440-1548
Mailing Address - Street 1:155 LIBERTY ST NE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3505
Mailing Address - Country:US
Mailing Address - Phone:503-440-1548
Mailing Address - Fax:503-967-7605
Practice Address - Street 1:155 LIBERTY ST NE
Practice Address - Street 2:SUITE 380
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3505
Practice Address - Country:US
Practice Address - Phone:503-440-1548
Practice Address - Fax:503-967-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL61011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty