Individual
IAN MACKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1904 SE DIVISION ST, PORTLAND, OR 97202
(503) 517-8663
Mailing address
1904 SE DIVISION ST, PORTLAND, OR 97202-1146
(503) 517-8663
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/09/2017
Last updated
06/27/2018
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