Individual
MARY NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1133 NW 21ST AVE, PORTLAND, OR 97209-1513
(503) 222-5010
Mailing address
1133 NW 21ST AVE, PORTLAND, OR 97209-1513
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0949
OR
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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