Provider Demographics
NPI:1518972918
Name:TASKER, KRISTI LYNN (LCSW R)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LYNN
Last Name:TASKER
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:SEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:503-233-2696
Practice Address - Street 1:7455 SW BEVELAND RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8610
Practice Address - Country:US
Practice Address - Phone:503-624-2600
Practice Address - Fax:503-624-7752
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0580571104100000X
ORL32591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000WDBCHOtherMEDICARE GROUP
OR164936Medicaid