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General NPI Number Information
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NPI Number | 1205050556
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Entity Type | Individual
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Provider Name | THERESA DIANNE CABALLERO ORTIZ LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 9300 NE OAK VIEW DR
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City | VANCOUVER
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State | WA
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Zip | 98662-6347
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Country | US
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Telephone | 360-567-2211
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Fax | 360-567-2212
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Provider Business Mailing Address
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Address Line | 10265 SW WALNUT STREET
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City | TIGARD
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State | OR
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Zip | 97223-5114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW 60541848
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License Number State | WA
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