Healthcare Provider Details

I. General information

NPI: 1679724298
Provider Name (Legal Business Name): ERIN VICTORIA SNEDDON VAN KLEEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN VICTORIA SNEDDON LCSW

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 SW WESTERN AVE
BEAVERTON OR
97005-3460
US

IV. Provider business mailing address

4855 SW WESTERN AVE
BEAVERTON OR
97005-3460
US

V. Phone/Fax

Practice location:
  • Phone: 503-520-4923
  • Fax: 503-626-4149
Mailing address:
  • Phone: 503-520-4923
  • Fax: 503-626-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL4145
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: