Provider Demographics
NPI:1386050318
Name:SIDELSKY, RIVKA (OREGON LPC C5730)
Entity type:Individual
Prefix:
First Name:RIVKA
Middle Name:
Last Name:SIDELSKY
Suffix:
Gender:F
Credentials:OREGON LPC C5730
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 NE EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-3017
Mailing Address - Country:US
Mailing Address - Phone:360-317-6528
Mailing Address - Fax:
Practice Address - Street 1:6115 NE EMERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-3017
Practice Address - Country:US
Practice Address - Phone:360-317-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional