Constance Joan Coquillette, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L3057 Issued in OR

Practice address

2410 SE 121St Ave Ste 216
Portland, OR 97216-4085

Phone

(971) 404-5174

Fax

(503) 335-5974

NPI assigned

Jul 14, 2009

Last updated

Jul 14, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Health Matters Northwest, LLC

  • Clinical Social Worker
  • Portland, OR
  • NPI 1851757686
  Authorized official Same address or phone
• Clinicops LLC

  dba Oregon Integrated Health

  • Internal Medicine Physician
  • Florence, OR
  • NPI 1497251268
  NPD (past)

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247529600000",
    "number": "1922237742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12105 NE 40TH CIR",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986826488",
            "telephone_number": "971-404-5174",
            "fax_number": "503-335-5974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SE 121ST AVE STE 216",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972164085",
            "telephone_number": "971-404-5174",
            "fax_number": "503-335-5974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COQUILLETTE",
        "first_name": "CONSTANCE",
        "middle_name": "JOAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-14",
        "last_updated": "2009-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L3057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Gene Copperman, DO
• Kimberly Coppersmith, PSY.D.
• Megan Coppock, CPM, LDM
• Inez Avena Coppola, L.AC.
• Peter G Coppola, P. T.
• Cora Forsten LLC
• Raina Corah, D.C.
• Nate J Corbell, LMT
• Elizabeth Corbett-Furgal
• Jana Marie Corbett, B.SC., M.SC., PH.D.

• Clinical Social Worker in Portland, OR
• Providers in Portland, 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 Jul 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.