Individual
KRISTINA CAROLYN HEADRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(503) 494-2762
Mailing address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(503) 494-2781
(503) 418-5215
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A4731
OR
Other
Enumeration date
07/11/2017
Last updated
11/23/2021
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