Individual
TIMOTHY HADDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 NE 7TH ST, GRESHAM, OR 97030-5604
(503) 661-5455
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/12/2019
Last updated
12/12/2019
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