Provider Demographics
NPI:1316084049
Name:RASCHKE, RENEE' LORENA (BS, QMHA, CADC 1,)
Entity type:Individual
Prefix:MS
First Name:RENEE'
Middle Name:LORENA
Last Name:RASCHKE
Suffix:
Gender:F
Credentials:BS, QMHA, CADC 1,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 NE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5016
Mailing Address - Country:US
Mailing Address - Phone:503-380-7796
Mailing Address - Fax:503-344-4412
Practice Address - Street 1:17070SE MCLOUGHLIN BLVD.
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267
Practice Address - Country:US
Practice Address - Phone:503-988-3747
Practice Address - Fax:503-988-3086
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-11-46101YA0400X
171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator