Fawn Gonzales LCSW LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5212 Issued in OR

Legal business name

FAWN GONZALES LCSW LLC

Practice address

14 Cottage St
Medford, OR 97504-7332

Phone

(541) 944-7711

NPI assigned

Dec 4, 2015

Last updated

Dec 4, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fawn GonzalesNPI 1295923787

Title

Owner

Phone

(541) 944-7711

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fawn Gonzales, LCSW LLC

  • Clinical Social Worker
  • Newport Beach, CA
  • NPI 1295923787

  OR

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449187200000",
    "number": "1417322231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 W BALBOA BLVD",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926634515",
            "telephone_number": "541-944-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 COTTAGE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047332",
            "telephone_number": "541-944-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAWN GONZALES LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-04",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "FAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-944-7711"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "5212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Fashbaugh
• Jason Fauble
• William Earl Faught, M.D.
• Erica M Faust
• Erin Fava
• Rahim Fazel, D.O.
• Mary Lynn Feagan, LPN
• Caitlin Rose Fears, L.M.T.
• Roseanne M Federico, RDHEF
• Martha Dale Feil

• Clinical Social Worker in Medford, OR
• Providers in Medford, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.