Basic Information
| Provider Information | |||||||||
| NPI: | 1386779635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALENDUFF | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | KIMBERLY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, CADC1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12636 SE STARK, PLAZA 125, BUILDING J | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032534600 | ||||||||
| FaxNumber: | 5032534609 | ||||||||
| Practice Location | |||||||||
| Address1: | 12636 SE STARK, PLAZA 125, BUILDING J | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032534600 | ||||||||
| FaxNumber: | 5032534609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 12/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | L4481 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.