Individual
RYAN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9847 N CENTRAL ST, PORTLAND, OR 97203-1503
(503) 708-5419
Mailing address
9847 N CENTRAL ST, PORTLAND, OR 97203-1503
(503) 708-5419
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L6342
OR
Other
Enumeration date
03/13/2015
Last updated
03/13/2015
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