Individual
LESLIE K BAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
51579 COLUMBIA RIVER HWY, STE 'I', SCAPPOOSE, OR 97056-8411
(503) 543-6164
(503) 543-6040
Mailing address
18100 SAUVIE ISLAND RD, PORTLAND, OR 97231-1311
(503) 248-1738
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2799
OR
Other
Enumeration date
05/01/2006
Last updated
10/03/2013
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