Provider Demographics
NPI:1366595720
Name:WORDEN, LORI J (LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:WORDEN
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 1:217 NE C ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2153
Mailing Address - Country:US
Mailing Address - Phone:541-476-5742
Mailing Address - Fax:541-476-5742
Practice Address - Street 1:217 NE C ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2153
Practice Address - Country:US
Practice Address - Phone:541-476-5742
Practice Address - Fax:541-476-5742
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL19261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP28769Medicare UPIN
ORR108993Medicare ID - Type Unspecified