Provider Demographics
NPI:1548735616
Name:CRADDOCK, KAIDEN ALEXANDER (LCSW)
Entity type:Individual
Prefix:
First Name:KAIDEN
Middle Name:ALEXANDER
Last Name:CRADDOCK
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:KAIRA
Other - Middle Name:
Other - Last Name:CRADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:319 SW WASHINGTON ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2615
Mailing Address - Country:US
Mailing Address - Phone:971-202-0677
Mailing Address - Fax:
Practice Address - Street 1:319 SW WASHINGTON ST STE 1001
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2615
Practice Address - Country:US
Practice Address - Phone:971-202-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health