Individual
CAROLYN LUCILLE CONSOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
(541) 766-6186
Mailing address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
(541) 766-6186
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW0001880
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500700084
—
OR
05
—
500732717
—
OR
Enumeration date
08/22/2007
Last updated
03/17/2018
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