Doctor Name: | JODIE RIZZOLO |
NPI Number: | 1063815199 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 8915 Sw Center St Tigard, OR - 972236307 |
Business Phone Number: | 5037263690 |
Business Fax Number: | |
Mailing Address: | 20988 Sw Sister Ln, BEAVERTON |
State: | OR |
Postal Code: | 970036028 |
Phone Number: | 5038400241 |
Fax Number: | |
NPI Enumeration Date: | 10/03/2014 |
NPI Last Update Date: | 10/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |