Provider Demographics
NPI:1982897583
Name:GONSIEWSKI, MARGARET NORENE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:NORENE
Last Name:GONSIEWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NORENE
Other - Middle Name:
Other - Last Name:GONSIEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4511 SE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3119
Mailing Address - Country:US
Mailing Address - Phone:503-234-4440
Mailing Address - Fax:503-200-5550
Practice Address - Street 1:287 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1430
Practice Address - Country:US
Practice Address - Phone:503-810-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR30451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR138708Medicare PIN