Individual
MS. GAIL SUSAN GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
119 NE 3RD ST, GRESHAM, OR 97030-7403
(503) 313-5369
Mailing address
PO BOX 2114, GRESHAM, OR 97030-0604
(503) 313-5369
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
7795
OR
Other
Enumeration date
08/26/2008
Last updated
08/26/2008
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