Provider Demographics
NPI:1417263468
Name:PRUDHOMME, LINDA L (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:PRUDHOMME
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 1:4938 SAWMILL RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9730
Mailing Address - Country:US
Mailing Address - Phone:503-990-1710
Mailing Address - Fax:503-435-6533
Practice Address - Street 1:4938 SAWMILL RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-9730
Practice Address - Country:US
Practice Address - Phone:503-990-1710
Practice Address - Fax:503-435-6469
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL26351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical