Provider Demographics
NPI:1477382091
Name:HERNANDEZ AYALA, YESENIA (MSW)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:HERNANDEZ AYALA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 BOURBON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1543
Mailing Address - Country:US
Mailing Address - Phone:503-265-9877
Mailing Address - Fax:
Practice Address - Street 1:2637 BOURBON ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1543
Practice Address - Country:US
Practice Address - Phone:503-265-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)