Individual
ELISE HANNAH LEIBOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(541) 758-5900
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(541) 758-5900
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10066323201
PROVIDENCE
OR
Enumeration date
01/11/2019
Last updated
01/11/2019
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