Individual
DAVID RAYMOND GOSTNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-4314
Mailing address
2327 NE 16TH AVE, PORTLAND, OR 97212-4227
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
600
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039326
—
OR
Enumeration date
08/01/2006
Last updated
07/08/2007
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