Organization
STREET LEAVES
Active
Other names
Stonesoup HRC
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW PETERSON (EXECUTIVE DIRECTOR)
(541) 231-5597
Entity
Organization
Contact information
Practice address
1235 SE OAK ST APT 2, PORTLAND, OR 97214-1498
(541) 231-5597
Mailing address
1235 SE OAK ST APT 2, PORTLAND, OR 97214-1498
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/08/2024
Last updated
04/11/2024
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