MEDICARE: MRS. ILIANA BEATRIZ HENRIQUEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L-8399	OR

General Provider Information

NPI Number	:	1053797167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILIANA BEATRIZ HENRIQUEZ LCSW

Provider Business Mailing Address
First Line	:	4896 SE LONE OAK ST
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-8665
Country	:	US
Telephone Number	:	971-344-2702
Fax Number	:	971-233-6370

Provider Business Practice Location Address
First Line	:	4896 SE LONE OAK ST
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-8665
Country	:	US
Telephone Number	:	971-344-2702
Fax Number	:	971-233-6370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	03/17/2026

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