Provider Demographics
NPI:1982124335
Name:RUNDLE, DEIRDRE JANE (LPC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:JANE
Last Name:RUNDLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 SE FRANCIS ST APT 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3586
Mailing Address - Country:US
Mailing Address - Phone:503-300-1941
Mailing Address - Fax:503-296-2959
Practice Address - Street 1:3651 SE FRANCIS ST APT 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3586
Practice Address - Country:US
Practice Address - Phone:503-300-1941
Practice Address - Fax:503-296-2959
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6461101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor