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General NPI Number Information
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NPI Number | 1356733430
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Entity Type | Individual
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Provider Name | ANGELICA GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 100 MULLINS DR STE A1
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City | LEBANON
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State | OR
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Zip | 97355-2868
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Country | US
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Telephone | 541-766-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 GREENWAY DR NE
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City | SALEM
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State | OR
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Zip | 97301-4535
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | OR
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