Individual
CRISTEN ELISSA VISCONTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CVT
Contact information
Practice address
17150 UNIVERSITY AVE, SUITE 100, SANDY, OR 97055-9290
(503) 668-6524
Mailing address
PO BOX 255, SANDY, OR 97055-0255
(971) 404-4092
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17417
OR
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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