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NPI Code Detail

MEDICARE: GRESSA WIDNER

MEDICARE: GRESSA WIDNER
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
1101YM0800XMental Health Counselor
2106S00000XBehavior Technician
3103K00000XBehavior AnalystABA-B-10250168OR

General Provider Information

NPI Number : 1265807069
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRESSA WIDNER
Provider Business Mailing Address
First Line : 3729 KLINDT DR
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3566
Country : US
Telephone Number : 541-298-2101
Fax Number : 541-298-7796
Provider Business Practice Location Address
First Line : 3729 KLINDT DR
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3566
Country : US
Telephone Number : 541-298-2101
Fax Number : 541-298-7796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2015
Last Update Date : 12/09/2024

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Directions to “ GRESSA WIDNER ” Practice Location

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