Provider Demographics
NPI:1871891424
Name:WITHEROW, REBECCA (LCSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:WITHEROW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15220 NW LAIDLAW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7717
Mailing Address - Country:US
Mailing Address - Phone:503-418-2000
Mailing Address - Fax:503-494-6968
Practice Address - Street 1:15220 NW LAIDLAW RD STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7717
Practice Address - Country:US
Practice Address - Phone:503-418-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA2642104100000X
ORL53441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker