Individual
MRS. QUINN ELLE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12008 SW GARDEN PL, TIGARD, OR 97223-8263
(503) 352-9608
Mailing address
8623 SW HOLLY LN UNIT 707, WILSONVILLE, OR 97070-8645
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7398
OR
Other
Enumeration date
02/09/2021
Last updated
02/09/2021
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