Provider Demographics
NPI:1528249695
Name:DE CACCIA, LINDA SUZANNE (EDM)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUZANNE
Last Name:DE CACCIA
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85600 LATTIN LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97455-9736
Mailing Address - Country:US
Mailing Address - Phone:541-747-8792
Mailing Address - Fax:
Practice Address - Street 1:85600 LATTIN LN
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:OR
Practice Address - Zip Code:97455-9736
Practice Address - Country:US
Practice Address - Phone:541-747-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health