Provider Demographics
NPI:1679629802
Name:SEABLOM, CRAIG JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JOHN
Last Name:SEABLOM
Suffix:
Gender:M
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MARYLHURST
Mailing Address - State:OR
Mailing Address - Zip Code:97036-0368
Mailing Address - Country:US
Mailing Address - Phone:503-380-7607
Mailing Address - Fax:503-697-6932
Practice Address - Street 1:2507 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97036-0368
Practice Address - Country:US
Practice Address - Phone:503-380-7607
Practice Address - Fax:503-697-6932
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR35111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical