Provider Demographics
NPI:1295856813
Name:SMITH-SLINGERLAND, KERRI (MSW, LCSW, CADC I, C)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:SMITH-SLINGERLAND
Suffix:
Gender:F
Credentials:MSW, LCSW, CADC I, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 N WILLAMETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5075
Mailing Address - Country:US
Mailing Address - Phone:503-494-4658
Mailing Address - Fax:503-418-5061
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD # 8-L
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-4658
Practice Address - Fax:503-418-5061
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL62941041C0700X
OR15-06-26U3101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126370Medicaid
OR0000WCQLVMedicaid