Individual
JOSEPH ULESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9615 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2297
Mailing address
9615 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2297
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-23-2490
OR
175T00000X
Peer Specialist
THW000108393
OR
Other
Enumeration date
03/31/2023
Last updated
10/02/2023
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