Provider Demographics
NPI:1790374635
Name:LADKE, LONNAMAE MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:LONNAMAE
Middle Name:MARGARET
Last Name:LADKE
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 1:4800 MEADOWS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5277
Mailing Address - Country:US
Mailing Address - Phone:541-543-4430
Mailing Address - Fax:
Practice Address - Street 1:4800 MEADOWS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5277
Practice Address - Country:US
Practice Address - Phone:971-201-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL64531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical