Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003202854 |
---|---|
Provider Name | Heather Cantu |
First Address | Ontario, OR 97914-3121 |
Second Address | Pendleton, OR 97801-2224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 08/04/2015 |