Provider Demographics
NPI:1235406018
Name:GINSBERG, ANNIKA AINA (LCSW, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ANNIKA
Middle Name:AINA
Last Name:GINSBERG
Suffix:
Gender:F
Credentials:LCSW, RD, LD
Other - Prefix:
Other - First Name:ANNIKA
Other - Middle Name:AINA
Other - Last Name:BACKSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5228 NE HOYT ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3055
Mailing Address - Country:US
Mailing Address - Phone:503-215-1518
Mailing Address - Fax:503-215-6477
Practice Address - Street 1:5228 NE HOYT ST BLDG B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3055
Practice Address - Country:US
Practice Address - Phone:503-215-1518
Practice Address - Fax:503-215-6477
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLDD000924133V00000X
ORL-105951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered