Provider Demographics
NPI:1437133584
Name:VANDERZANDEN, JONNIE MCRAE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JONNIE
Middle Name:MCRAE
Last Name:VANDERZANDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 SW EASTRIDGE ST
Mailing Address - Street 2:#110C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5030
Mailing Address - Country:US
Mailing Address - Phone:503-292-2780
Mailing Address - Fax:503-292-2721
Practice Address - Street 1:10490 SW EASTRIDGE ST
Practice Address - Street 2:#110C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5030
Practice Address - Country:US
Practice Address - Phone:503-292-2780
Practice Address - Fax:503-292-2721
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health