Provider Demographics
NPI:1902018336
Name:RATTERMAN, SHELLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:RATTERMAN
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 1:1215 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1711
Mailing Address - Country:US
Mailing Address - Phone:503-756-2586
Mailing Address - Fax:
Practice Address - Street 1:1215 SW 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1711
Practice Address - Country:US
Practice Address - Phone:503-756-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR31221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR291127OtherMANAGED HLTH NETWORK
OR112638Medicare ID - Type Unspecified