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General NPI Number Information
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NPI Number | 1851281802
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Entity Type | Individual
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Provider Name | CONSUELO ICOVINO
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 11211 SE 82ND AVE STE O
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-7641
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Country | US
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Telephone | 503-722-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 2051 KAEN RD STE 154
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City | OREGON CITY
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State | OR
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Zip | 97045-4035
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Country | US
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Telephone | 503-722-6200
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Fax | 503-722-6545
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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 | L8368
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License Number State | OR
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