Healthcare Provider Details

I. General information

NPI: 1366224438
Provider Name (Legal Business Name): CECILIA LYNN ZOELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW CIVIC DR STE 310
GRESHAM OR
97030-3774
US

IV. Provider business mailing address

1700 NW CIVIC DR STE 310
GRESHAM OR
97030-3774
US

V. Phone/Fax

Practice location:
  • Phone: 503-699-4300
  • Fax:
Mailing address:
  • Phone: 503-666-8832
  • Fax: 503-669-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL7406
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: