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Individual

CRISSY K PHOMMACHACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
14843 SE PARKLANE DR APT 146, HAPPY VALLEY, OR 97015-5537
(503) 575-5130
Mailing address
2735 NE 82ND AVE, PORTLAND, OR 97220-5304

Taxonomy

Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
529810
OR

Other

Enumeration date
10/27/2025
Last updated
10/27/2025
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