MEDICARE: MRS. CARLA WIDELL GERBER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L4528	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225111727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLA WIDELL GERBER LCSW

Provider Business Mailing Address
First Line	:	3800 SPORTS WAY
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-2019
Country	:	US
Telephone Number	:	541-434-1527
Fax Number	:	541-434-1527

Provider Business Practice Location Address
First Line	:	3800 SPORTS WAY
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-2019
Country	:	US
Telephone Number	:	541-434-1527
Fax Number	:	541-434-1527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/30/2026

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