Individual
BRIDGET N CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
5009 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1915
(503) 284-1794
(503) 284-2093
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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