Individual
KYLA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 NW VAUGHN ST STE 140, PORTLAND, OR 97210-5344
(503) 499-5200
Mailing address
1305 NE 71ST AVE, PORTLAND, OR 97213-5458
(503) 730-1416
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A3008
OR
Other
Enumeration date
04/22/2013
Last updated
03/07/2022
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