Provider Demographics
NPI:1518001734
Name:VANDER, REGINA E (LCSW)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:E
Last Name:VANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:E
Other - Last Name:ECKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4742 LIBERTY RD. S.
Mailing Address - Street 2:#525
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5037
Mailing Address - Country:US
Mailing Address - Phone:503-858-5867
Mailing Address - Fax:503-815-2383
Practice Address - Street 1:4742 LIBERTY RD. S.
Practice Address - Street 2:#525
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5037
Practice Address - Country:US
Practice Address - Phone:503-858-5867
Practice Address - Fax:503-815-2383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38591041C0700X
OR38591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical