Provider Demographics
NPI:1992039317
Name:GILBERTSON, ANNETTE FAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:FAYE
Last Name:GILBERTSON
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 1:708 SW DESCHUTES AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2253
Mailing Address - Country:US
Mailing Address - Phone:541-408-6297
Mailing Address - Fax:855-612-0578
Practice Address - Street 1:708 SW DESCHUTES AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2253
Practice Address - Country:US
Practice Address - Phone:541-408-6297
Practice Address - Fax:855-612-0578
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR41791041C0700X
CA237711041C0700X
ORL41791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR193229Medicare UPIN
CACM671AMedicare UPIN