Individual
LOLA AMINOVA RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2738 NE BROADWAY ST, PORTLAND, OR 97232-1723
(503) 308-8392
Mailing address
2738 NE BROADWAY ST, PORTLAND, OR 97232-1723
(503) 308-8392
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L10543
OR
Other
Enumeration date
10/20/2015
Last updated
03/05/2025
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