Provider Demographics
NPI:1790199156
Name:GJERDE, KARI RUTH (LPC, MA)
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:RUTH
Last Name:GJERDE
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 NE MARTIN LUTHER KING JR BLVD # 208
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3727
Mailing Address - Country:US
Mailing Address - Phone:503-388-8649
Mailing Address - Fax:
Practice Address - Street 1:2225 NE MLK JR BLVD # 208
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3727
Practice Address - Country:US
Practice Address - Phone:503-388-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health