Individual
BONITA BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 NE 7TH STREET, GRESHAM, OR 97030
(503) 661-5455
Mailing address
14600 NW CORNELL ROAD, PORTLAND, OR 97229
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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