Individual
DANA TICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
4310 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1404
(503) 535-1181
Mailing address
1312 SW WASHINGTON ST, PO BOX 3007, PORTLAND, OR 97205-2327
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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