Organization
CLACKAMAS EDUCATION SERVICE DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ANTHONY GALLIA PHD (MEDICAID BILLING SPECIALIST)
(503) 675-4151
Entity
Organization
Contact information
Practice address
13455 SE 97TH, CLACKAMAS, OR 97015
(503) 675-4151
Mailing address
13455 SE 97TH, CLACKAMAS, OR 97015
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045737
SCHOOL BASED PROVIDER
OR
Enumeration date
12/19/2006
Last updated
10/12/2021
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