| Fawn Gonzales Lcsw Llc | |
|
14 Cottage St Medford OR 97504-7332 | |
| (541) 944-7711 | |
| Not Available |
| Full Name | Fawn Gonzales Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 14 Cottage St, Medford, Oregon |
| Authorized Official Name and Position | Fawn Gonzales (OWNER) |
| Authorized Official Contact | 5419447711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fawn Gonzales Lcsw Llc 1820 W Balboa Blvd Newport Beach CA 92663-4515 Ph: (541) 944-7711 | Fawn Gonzales Lcsw Llc 14 Cottage St Medford OR 97504-7332 Ph: (541) 944-7711 |
| NPI Number | 1417322231 |
|---|---|
| Provider Enumeration Date | 12/04/2015 |
| Last Update Date | 12/04/2015 |
| Medicare PECOS PAC ID | 3274835608 |
|---|---|
| Medicare Enrollment ID | O20151231001127 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417322231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 5212 (Oregon) | Primary |
| Provider Name | Fawn Gonzales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295923787 PECOS PAC ID: 4183926512 Enrollment ID: I20151231001392 |
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