Individual
MARK WALLACE HONEYWELL SUMMIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
637 N FARRAGUT ST, PORTLAND, OR 97217-1473
(503) 715-6298
Mailing address
637 N FARRAGUT ST, PORTLAND, OR 97217-1473
(503) 715-6298
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2534
OR
Other
Enumeration date
02/25/2020
Last updated
02/25/2020
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