Individual
DIANA GRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSSA, LCSW
Contact information
Practice address
870 82ND DR, GLADSTONE, OR 97027-1803
(503) 659-5515
Mailing address
PO BOX 82819, PORTLAND, OR 97282-0819
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
112446
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
11/04/2013
Last updated
03/23/2024
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