Individual
MRS. NICOLE LAVONNE ALTSTADT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, CSWA
Contact information
Practice address
4295 SW TEGART LN, GRESHAM, OR 97080-8653
(503) 545-9939
Mailing address
4295 SW TEGART LN, GRESHAM, OR 97080-8653
(503) 545-9939
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A5691
OR
Other
Enumeration date
01/08/2022
Last updated
01/08/2022
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