Provider Demographics
NPI:1033850508
Name:AGUIRRE-WILKINSON, ILCE A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ILCE
Middle Name:A
Last Name:AGUIRRE-WILKINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6438 TEPPER PARK WAY NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-1185
Mailing Address - Country:US
Mailing Address - Phone:503-989-8055
Mailing Address - Fax:
Practice Address - Street 1:6438 TEPPER PARK WAY NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-1185
Practice Address - Country:US
Practice Address - Phone:503-989-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL83591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty