Provider Demographics
NPI:1891217584
Name:HARTMAN, GABRIELA ROSE
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ROSE
Last Name:HARTMAN
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 1:707 NE COUCH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2922
Mailing Address - Country:US
Mailing Address - Phone:503-542-4603
Mailing Address - Fax:503-233-6093
Practice Address - Street 1:3632 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-7453
Practice Address - Country:US
Practice Address - Phone:971-352-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker