Provider Demographics
NPI:1023089810
Name:ROCKWELL, LINDA CLIFFORD (MSW LCSW BCD)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CLIFFORD
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2188 SW PARK PL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1100
Mailing Address - Country:US
Mailing Address - Phone:503-241-3606
Mailing Address - Fax:503-294-0899
Practice Address - Street 1:2188 SW PARK PL
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1100
Practice Address - Country:US
Practice Address - Phone:503-241-3606
Practice Address - Fax:503-294-0899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008297Medicaid
OR008297Medicaid