Provider Demographics
NPI:1396522355
Name:VERA GONZALEZ, PATRICIA IRMA (CADCII)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:IRMA
Last Name:VERA GONZALEZ
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1028
Mailing Address - Country:US
Mailing Address - Phone:503-866-4642
Mailing Address - Fax:
Practice Address - Street 1:775 SW MADISON ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1028
Practice Address - Country:US
Practice Address - Phone:503-866-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-P-18101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)