Individual
CONSUELO ICOVINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11211 SE 82ND AVE STE O, HAPPY VALLEY, OR 97086-7641
(503) 722-6200
Mailing address
2051 KAEN RD STE 154, OREGON CITY, OR 97045-4035
(503) 722-6200
(503) 722-6545
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L8368
OR
Other
Enumeration date
07/09/2025
Last updated
07/10/2025
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