Individual
NICOLE RENE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229
(503) 645-3581
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A15312
OR
171M00000X
Case Manager/Care Coordinator
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
01/04/2017
Last updated
07/01/2024
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