Individual
BRENDA L MIGGINS-VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4423 NE TILLAMOOK ST # A, PORTLAND, OR 97213-1317
(503) 850-7979
(888) 501-7621
Mailing address
4423 NE TILLAMOOK ST # A, PORTLAND, OR 97213-1317
(503) 850-7979
(888) 501-7621
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1306203831
OR
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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