Provider Demographics
NPI:1013765569
Name:VALADEZ, ELIZABETH L (CRM/PSS)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:L
Last Name:VALADEZ
Suffix:
Gender:F
Credentials:CRM/PSS
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:VALADEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRM/PSS
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:620 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7514
Practice Address - Country:US
Practice Address - Phone:971-274-3757
Practice Address - Fax:503-912-5740
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110823175T00000X
OR24-CRM-2844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist