Individual
MICHELE A GILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, BCD
Contact information
Practice address
480 5TH ST, LAKE OSWEGO, OR 97034-3079
(503) 349-4435
Mailing address
PO BOX 267, LAKE OSWEGO, OR 97034-0031
(503) 349-4435
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2291
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
22959
—
OR
01
—
R150985
MEDICARE IDENTIFICATION NUMBER
OR
Enumeration date
06/26/2006
Last updated
06/02/2022
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