Provider Demographics
NPI:1558080713
Name:BAHRENBURG, ANISSA RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:RENEE
Last Name:BAHRENBURG
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 1:8040 SE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8414
Mailing Address - Country:US
Mailing Address - Phone:503-807-2912
Mailing Address - Fax:
Practice Address - Street 1:2133 NE BROADWAY ST STE 303
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1878
Practice Address - Country:US
Practice Address - Phone:503-807-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR44191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical