Provider Demographics
NPI:1730428251
Name:GILDEA, LAURA CELEDRA
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CELEDRA
Last Name:GILDEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 NW KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1400
Mailing Address - Country:US
Mailing Address - Phone:971-258-7252
Mailing Address - Fax:
Practice Address - Street 1:1962 NW KEARNEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1400
Practice Address - Country:US
Practice Address - Phone:971-258-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC#C2738101YP2500X
CAMFT33178106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist