Individual
JENNIFER LUDTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5210 N KERBY AVE, PORTLAND, OR 97217-2699
(559) 707-1953
Mailing address
1739 NE 47TH AVE, PORTLAND, OR 97213-2009
(559) 707-1953
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000018517
CA
2255A2300X
Athletic Trainer
AT-AT-10206431
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT-AT-10206431
STATE LICENSURE
OR
Enumeration date
08/11/2014
Last updated
01/24/2022
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