Healthcare Provider Details

I. General information

NPI: 1831133461
Provider Name (Legal Business Name): NOE ALONZO MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 NE HALSEY ST STE 335
PORTLAND OR
97213-1568
US

IV. Provider business mailing address

826 EASTLAND DR
TWIN FALLS ID
83301-6858
US

V. Phone/Fax

Practice location:
  • Phone: 503-922-6616
  • Fax: 971-209-7230
Mailing address:
  • Phone: 208-737-6715
  • Fax: 210-922-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32270
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18663
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-41680
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: