Individual
JACQUELINE ELIZABETH GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1918 NE 143RD AVE, PORTLAND, OR 97230-4101
(503) 726-9630
Mailing address
1918 NE 143RD AVE, PORTLAND, OR 97230-4101
(503) 726-9630
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7655
OR
1041C0700X
Clinical Social Worker
LW60770104
WA
Other
Enumeration date
06/27/2013
Last updated
01/27/2020
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