Individual
MS. TERESA A GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4906 SW 1ST AVE, PORTLAND, OR 97239-2883
(503) 295-0600
Mailing address
4906 SW 1ST AVE, PORTLAND, OR 97239-2883
(503) 295-0600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10140
OR
174400000X
Specialist
MA00017683
WA
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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