Individual
LYNN ALICE EMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, RN, CADCI
Contact information
Practice address
5128 NE 42ND AVE, PORTLAND, OR 97218-1506
(971) 930-2586
Mailing address
6305 NE PRESCOTT ST, PORTLAND, OR 97218-3247
(503) 522-9655
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12-09-11
OR
1041C0700X
Clinical Social Worker
Primary
L6659
OR
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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