Healthcare Provider Details

I. General information

NPI: 1598095531
Provider Name (Legal Business Name): LESLIE ANN GELLERT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6274 SW CAPITOL HWY
PORTLAND OR
97239-2674
US

IV. Provider business mailing address

6274 SW CAPITOL HWY
PORTLAND OR
97239-2674
US

V. Phone/Fax

Practice location:
  • Phone: 971-290-8458
  • Fax:
Mailing address:
  • Phone: 971-290-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5305
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: