Basic Information
| Provider Information | |||||||||
| NPI: | 1942407259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRILLO | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | BRANDI | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2757 NW CANYON DR | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413184845 | ||||||||
| FaxNumber: | 5413185156 | ||||||||
| Practice Location | |||||||||
| Address1: | 63360 BRITTA ST BUILDING 1 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413184845 | ||||||||
| FaxNumber: | 5413185156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.