Provider Demographics
NPI:1407135833
Name:ROEDA, KATIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ROEDA
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 1:14535 WESTLAKE DR
Mailing Address - Street 2:STE B
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7775
Mailing Address - Country:US
Mailing Address - Phone:503-440-1548
Mailing Address - Fax:503-967-7605
Practice Address - Street 1:14535 WESTLAKE DR
Practice Address - Street 2:STE B
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7775
Practice Address - Country:US
Practice Address - Phone:503-440-1548
Practice Address - Fax:503-967-7605
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL61011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical