Individual
CHARLES E RETHLEFSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
Mailing address
PO BOX 579, CORVALLIS, OR 97339-0579
(541) 766-6835
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L1045
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065883
—
OR
Enumeration date
04/17/2006
Last updated
07/09/2007
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