Individual
MS. BETHE ANN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2625 SE HAWTHORNE BLVD, PORTLAND, OR 97214-2941
(503) 238-9788
Mailing address
4428 NE 74TH AVE, PORTLAND, OR 97218
(503) 481-4435
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
11341
OR
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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