Provider Demographics
NPI:1861538225
Name:SISEMORE, LINDA LOUISE (BS, CADC I)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOUISE
Last Name:SISEMORE
Suffix:
Gender:F
Credentials:BS, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12652 WOODPECKER DR SE
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:OR
Mailing Address - Zip Code:97392-9731
Mailing Address - Country:US
Mailing Address - Phone:503-399-7400
Mailing Address - Fax:503-399-7575
Practice Address - Street 1:12652 WOODPECKER DR SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9731
Practice Address - Country:US
Practice Address - Phone:503-399-7400
Practice Address - Fax:503-399-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03-11-50101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator