Provider Demographics
NPI:1366614828
Name:SIAK, NADINE LEAVITT
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:LEAVITT
Last Name:SIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:LEAVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8042 SE CLAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215
Mailing Address - Country:US
Mailing Address - Phone:503-774-2828
Mailing Address - Fax:
Practice Address - Street 1:722 NE 162ND AVE
Practice Address - Street 2:ALBERTINA KERR CENTERS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230
Practice Address - Country:US
Practice Address - Phone:503-253-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor