Individual
MISS MISTY MARIE GOTTSCHALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
3180 CENTER ST NE, SALEM, OR 97301-4532
(503) 362-5918
Mailing address
3375 DUNCAN AVE NE, SALEM, OR 97301-0809
(503) 302-7196
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/20/2011
Last updated
08/20/2011
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