Provider Demographics
NPI:1295884658
Name:STRATTON, RITA A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:A
Last Name:STRATTON
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 1:2116 NE 165TH DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5562
Mailing Address - Country:US
Mailing Address - Phone:503-257-6759
Mailing Address - Fax:503-257-2985
Practice Address - Street 1:333 SE 223RD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7454
Practice Address - Country:US
Practice Address - Phone:503-661-7733
Practice Address - Fax:503-661-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1721OtherOR..LCSW LICENSE NUMBER
OR115329Medicare ID - Type Unspecified