Provider Demographics
NPI:1114079696
Name:ABEL, AGNES (LCSW)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:ABEL
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 1:1911 MT VIEW LN
Mailing Address - Street 2:#500
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2248
Mailing Address - Country:US
Mailing Address - Phone:503-357-0206
Mailing Address - Fax:503-357-9003
Practice Address - Street 1:1911 MT VIEW LN
Practice Address - Street 2:#500
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2248
Practice Address - Country:US
Practice Address - Phone:503-357-0206
Practice Address - Fax:503-357-9003
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TLBKXMedicare ID - Type Unspecified