Provider Demographics
NPI:1093145930
Name:GAPEN, ROSANNA
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:GAPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 NE ORENCO STATION PKWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5409
Mailing Address - Country:US
Mailing Address - Phone:815-914-1822
Mailing Address - Fax:
Practice Address - Street 1:6825 SW SANDBURG ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8192
Practice Address - Country:US
Practice Address - Phone:815-914-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5037101YP2500X
IL178.009428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional