MEDICARE: MICHELE A GILSON LCSW, BCD

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	L2291	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R150985	OTHER	OR	MEDICARE IDENTIFICATION NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548297575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE A GILSON LCSW, BCD

Provider Business Mailing Address
First Line	:	PO BOX 267
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-0031
Country	:	US
Telephone Number	:	503-349-4435
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 5TH ST
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3079
Country	:	US
Telephone Number	:	503-349-4435
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	06/02/2022

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