Provider Demographics
NPI:1720456825
Name:ORDAZ-ROGERS, OLIVIA (LCSW, CADC 1)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ORDAZ-ROGERS
Suffix:
Gender:F
Credentials:LCSW, CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WILLAMETTE ST STE 412
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2688
Mailing Address - Country:US
Mailing Address - Phone:541-515-6942
Mailing Address - Fax:
Practice Address - Street 1:541 WILLAMETTE ST STE 412
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2688
Practice Address - Country:US
Practice Address - Phone:541-515-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-18-248101YA0400X
101YM0800X
ORL103431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500704899Medicaid
OR500743988Medicaid