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General NPI Number Information
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NPI Number | 1831749985
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Entity Type | Individual
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Provider Name | RACHEL PETKE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 2800 N VANCOUVER AVE STE 207
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City | PORTLAND
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State | OR
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Zip | 97227-1630
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Country | US
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Telephone | 503-276-9000
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Fax | 503-276-9010
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Provider Business Mailing Address
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Address Line | PO BOX 4037
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City | PORTLAND
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State | OR
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Zip | 97208-4037
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Country | US
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Telephone | 503-413-4048
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Fax | 503-413-2910
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3240
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L3240
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License Number State | OR
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