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Individual

UNKNOWN ONI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3702
Mailing address
12210 SW MAIN ST UNIT 23854, TIGARD, OR 97281-0839
(360) 768-8943

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
05/23/2018
Last updated
05/23/2018
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