Provider Demographics
NPI:1326443961
Name:KIRKALDIE, ELZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELZABETH
Middle Name:
Last Name:KIRKALDIE
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 1:4225 SE WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7406
Mailing Address - Country:US
Mailing Address - Phone:503-869-8774
Mailing Address - Fax:
Practice Address - Street 1:4431 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6271
Practice Address - Country:US
Practice Address - Phone:503-869-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL53321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical