Individual
MRS. MARISELA VAN SICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7420 SW GARDEN HOME RD STE A, PORTLAND, OR 97223-9599
(503) 713-6498
Mailing address
7420 SW GARDEN HOME RD STE A, PORTLAND, OR 97223-9599
(503) 713-6498
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7127
OR
Other
Enumeration date
01/24/2014
Last updated
07/11/2024
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