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General NPI Number Information
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NPI Number | 1467049619
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Entity Type | Individual
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Provider Name | GINA DELEO
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Gender | Female
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 440 MYERS ST S
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City | SALEM
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State | OR
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Zip | 97302-4330
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Country | US
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Telephone | 971-236-4187
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Fax | 971-346-4474
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Provider Business Mailing Address
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Address Line | 1915 NE STUCKI AVE STE 308
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City | HILLSBORO
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State | OR
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Zip | 97006-6951
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Country | US
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Telephone | 971-236-4187
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Fax | 971-346-4474
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | R7224
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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