Healthcare Provider Details

I. General information

NPI: 1043668262
Provider Name (Legal Business Name): JORDANA KRUEGER-TOSCHER, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE STE 201B
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

5816 NE 25TH AVE
PORTLAND OR
97211-6130
US

V. Phone/Fax

Practice location:
  • Phone: 971-270-0741
  • Fax: 757-257-7460
Mailing address:
  • Phone: 347-277-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6607
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JORDANA KRUEGER-TOSCHER
Title or Position: OWNER
Credential:
Phone: 347-277-2553