Provider Demographics
NPI:1316773278
Name:DIAZ, ISABELA GRACE (CSWA, MSW)
Entity type:Individual
Prefix:
First Name:ISABELA
Middle Name:GRACE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CSWA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 SW OLESON RD APT D4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1447
Mailing Address - Country:US
Mailing Address - Phone:405-802-1610
Mailing Address - Fax:
Practice Address - Street 1:1201 SW 12TH AVE STE 224
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2083
Practice Address - Country:US
Practice Address - Phone:971-251-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA15543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker