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NPI Code Detail

MEDICARE: KATHRYN R RIDGEWAY LCSW

MEDICARE: KATHRYN R RIDGEWAY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2104100000XSocial WorkerLSW.0009921498CO
3101YA0400XAddiction (Substance Use Disorder) CounselorCANDIDATEOR
41041C0700XClinical Social WorkerL8005OR

General Provider Information

NPI Number : 1689926974
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN R RIDGEWAY LCSW
Provider Business Mailing Address
First Line : 4800 MEADOWS RD STE 300
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5277
Country : US
Telephone Number : 971-201-1720
Fax Number : 503-210-9250
Provider Business Practice Location Address
First Line : 4800 MEADOWS RD STE 300
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5277
Country : US
Telephone Number : 971-201-1720
Fax Number : 503-210-9250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2012
Last Update Date : 05/27/2026

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