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Individual

MR. JOHNIE LYNN BRADFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
(503) 690-9605
Mailing address
4207 N KERBY AVE, PORTLAND, OR 97217-3035
(503) 388-0697

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
OR

Other

Enumeration date
05/15/2012
Last updated
05/15/2012
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