Provider Demographics
NPI:1336738996
Name:KLIPP, GRETCHEN GEUDER (LCSW)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:GEUDER
Last Name:KLIPP
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 1:4345 N HAIGHT AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2986
Mailing Address - Country:US
Mailing Address - Phone:616-218-3234
Mailing Address - Fax:
Practice Address - Street 1:4055 SW GARDEN HOME RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3664
Practice Address - Country:US
Practice Address - Phone:971-319-4827
Practice Address - Fax:503-662-6221
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL126471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical