Individual
CAOLAN DONAL CONRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Mailing address
5420 SE 62ND AVE, PORTLAND, OR 97206-5408
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/27/2023
Last updated
01/27/2026
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