Provider Demographics
NPI:1841551892
Name:VILLEDA, ILEANA (LCSW)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:VILLEDA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 257S
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-747-9502
Mailing Address - Fax:877-744-1853
Practice Address - Street 1:8800 SE SUNNYSIDE RD STE 257S
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5738
Practice Address - Country:US
Practice Address - Phone:503-747-9502
Practice Address - Fax:877-744-1853
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL79341041C0700X, 106H00000X, 171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator