Individual
SAMANTHA GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
12612 SE STARK ST BLDG M, PORTLAND, OR 97233-1058
(503) 906-9995
Mailing address
12612 SE STARK ST BLDG M, PORTLAND, OR 97233-1058
(503) 906-9995
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
25-CRM-5008
OR
Other
Enumeration date
11/17/2025
Last updated
11/21/2025
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