Provider Demographics
NPI:1871190900
Name:ELIZABETH, GIANNI (MSW, CSWA)
Entity Type:Individual
Prefix:
First Name:GIANNI
Middle Name:
Last Name:ELIZABETH
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SW WILSON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3373
Mailing Address - Country:US
Mailing Address - Phone:541-797-3350
Mailing Address - Fax:
Practice Address - Street 1:233 SW WILSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3373
Practice Address - Country:US
Practice Address - Phone:541-797-3350
Practice Address - Fax:541-610-1887
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty