Provider Demographics
NPI:1699456954
Name:DALKE, OLIVIA JOELLE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JOELLE
Last Name:DALKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SW NATALIE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1219
Mailing Address - Country:US
Mailing Address - Phone:503-339-6279
Mailing Address - Fax:
Practice Address - Street 1:9201 SE FOSTER RD # 207
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4644
Practice Address - Country:US
Practice Address - Phone:503-967-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health