Provider Demographics
NPI:1437290939
Name:RONDEMA, JENNIFER E (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:RONDEMA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33350
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-3350
Mailing Address - Country:US
Mailing Address - Phone:503-595-2782
Mailing Address - Fax:503-761-7917
Practice Address - Street 1:14815 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2336
Practice Address - Country:US
Practice Address - Phone:503-761-7139
Practice Address - Fax:503-761-7917
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCSWA A18861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical