Individual
ALYSSA J DISTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2020 SE POWELL BLVD, PORTLAND, OR 97202-2345
(310) 259-9136
Mailing address
2020 SE POWELL BLVD, PORTLAND, OR 97202-2345
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54023227
KAISER PERMANENTE
OR
Enumeration date
04/15/2019
Last updated
04/15/2019
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