Provider Demographics
NPI:1366224438
Name:ZOELLER, CECILIA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:LYNN
Last Name:ZOELLER
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 1:1700 NW CIVIC DR STE 310
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3774
Mailing Address - Country:US
Mailing Address - Phone:503-666-8832
Mailing Address - Fax:503-669-8641
Practice Address - Street 1:1700 NW CIVIC DR STE 310
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3774
Practice Address - Country:US
Practice Address - Phone:503-699-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL7406104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker