Provider Demographics
NPI:1013654698
Name:STRETCH-MENDOZA, ISABELLA PERRY (QMHA-I, CHW)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:PERRY
Last Name:STRETCH-MENDOZA
Suffix:
Gender:F
Credentials:QMHA-I, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 G ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4113
Mailing Address - Country:US
Mailing Address - Phone:541-735-9420
Mailing Address - Fax:
Practice Address - Street 1:1435 G ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4113
Practice Address - Country:US
Practice Address - Phone:541-735-9420
Practice Address - Fax:541-747-9870
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker