Individual
AMANDA WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11097 SE 21ST AVE, MILWAUKIE, OR 97222-7640
(971) 803-8055
Mailing address
11097 SE 21ST AVE, MILWAUKIE, OR 97222-7640
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
07/05/2017
Last updated
07/05/2017
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