Healthcare Provider Details

I. General information

NPI: 1841551892
Provider Name (Legal Business Name): ILEANA VILLEDA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 SE SUNNYSIDE RD STE 257S
CLACKAMAS OR
97015-5738
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 257S
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-9502
  • Fax: 877-744-1853
Mailing address:
  • Phone: 503-747-9502
  • Fax: 877-744-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7934
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL7934
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberL7934
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL7934
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: