Individual
MAYA HUMPHRIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
8810 SE SUNNYBROOK BLVD, SUITE 100, CLACKAMAS, OR 97015-6843
(503) 607-2226
(503) 659-2276
Mailing address
1375 NE 26TH ST, GRESHAM, OR 97030-3029
(360) 989-6129
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17687
OR
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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