Individual
CAROL MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1184 MCGEE CT NE, KEIZER, OR 97303-9443
(503) 304-4358
(503) 304-4361
Mailing address
PO BOX 20674, KEIZER, OR 97307-0674
(503) 304-4358
(503) 304-4361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-21-802
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-21-802
MHACBO
OR
Enumeration date
07/07/2021
Last updated
07/07/2021
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