Healthcare Provider Details

I. General information

NPI: 1275272155
Provider Name (Legal Business Name): LETICIA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 LIBERTY ST NE # 202D
SALEM OR
97301-3682
US

IV. Provider business mailing address

189 LIBERTY ST NE # 202D
SALEM OR
97301-3682
US

V. Phone/Fax

Practice location:
  • Phone: 971-205-2783
  • Fax: 971-205-2784
Mailing address:
  • Phone: 971-205-2783
  • Fax: 971-205-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18088
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: