Provider Demographics
NPI:1710146584
Name:SCHWANKE, KIRSTEN (MA LPC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:SCHWANKE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 SW SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3830
Mailing Address - Country:US
Mailing Address - Phone:503-244-8316
Mailing Address - Fax:
Practice Address - Street 1:3422 SW SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3830
Practice Address - Country:US
Practice Address - Phone:502-244-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional