Provider Demographics
NPI:1568614873
Name:LAURITSEN, ANN F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:F
Last Name:LAURITSEN
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 1:7336 SE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6121
Mailing Address - Country:US
Mailing Address - Phone:503-233-1026
Mailing Address - Fax:
Practice Address - Street 1:2701 NW VAUGHN ST STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5344
Practice Address - Country:US
Practice Address - Phone:503-499-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3657104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker