Individual
MR. SEAN ROBERT DERRICKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
4610 SE BELMONT ST, SUITE 10, PORTLAND, OR 97215-1752
(503) 988-4450
Mailing address
4610 SE BELMONT ST, SUITE 10, PORTLAND, OR 97215-1752
(503) 988-4450
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3242
OR
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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