Individual
AMY JENNIFER MALIA CROCKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 SW MACADAM AVE, # 580, PORTLAND, OR 97239
(503) 231-7854
Mailing address
5200 SW MACADAM AVE, # 580, PORTLAND, OR 97239
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/26/2011
Last updated
12/02/2015
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