Individual
GLENDA STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2308 NE KILLINGSWORTH ST, PORTLAND, OR 97211-5541
(503) 238-0769
Mailing address
2308 NE KILLINGSWORTH ST, PORTLAND, OR 97211-5541
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/15/2007
Last updated
10/15/2007
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