Individual
JEFFREY RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3500 NE MLK BLVD STE 200, PORTLAND, OR 97212-2093
(503) 327-8205
Mailing address
PO BOX 82819, PORTLAND, OR 97282-0819
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7994
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/08/2015
Last updated
03/12/2019
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