Provider Demographics
NPI:1508954314
Name:KO LOVE, ROAMMIE HELEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROAMMIE
Middle Name:HELEN
Last Name:KO LOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROAMMIE
Other - Middle Name:HELEN
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:18765 SW BOONES FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:503-984-5350
Mailing Address - Fax:
Practice Address - Street 1:265 SE OAK ST STE E
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3970
Practice Address - Country:US
Practice Address - Phone:503-439-9531
Practice Address - Fax:503-531-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041C0700X
ORL34801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A