Healthcare Provider Details

I. General information

NPI: 1124935861
Provider Name (Legal Business Name): DELANIE CONZELMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 NE 44TH AVE STE 390
PORTLAND OR
97213-1461
US

IV. Provider business mailing address

10288 NE EVERGREEN PKWY APT 335
HILLSBORO OR
97124-8195
US

V. Phone/Fax

Practice location:
  • Phone: 503-963-6494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: