Provider Demographics
NPI:1316199102
Name:REICKER, KATHLEEN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:REICKER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NW NAITO PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2830
Mailing Address - Country:US
Mailing Address - Phone:503-224-5241
Mailing Address - Fax:
Practice Address - Street 1:1200 NW NAITO PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2830
Practice Address - Country:US
Practice Address - Phone:503-224-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
OR3981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst