Individual
SPRING LIBERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3034 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97212-3053
(503) 283-3763
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/22/2010
Last updated
02/22/2010
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