Healthcare Provider Details

I. General information

NPI: 1689926974
Provider Name (Legal Business Name): KATHRYN R RIDGEWAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE RIDGEWAY

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEADOWS RD STE 300
LAKE OSWEGO OR
97035-5277
US

IV. Provider business mailing address

4800 MEADOWS RD STE 300
LAKE OSWEGO OR
97035-5277
US

V. Phone/Fax

Practice location:
  • Phone: 971-201-1720
  • Fax: 503-210-9250
Mailing address:
  • Phone: 971-201-1720
  • Fax: 503-210-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCANDIDATE
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009921498
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL8005
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: