Individual
ANGELA FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12511 SW 68TH AVE, SUITE 100, PORTLAND, OR 97223-8510
(503) 719-2420
Mailing address
12511 SW 68TH AVE, SUITE 100, PORTLAND, OR 97223-8510
(503) 719-2420
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/27/2013
Last updated
07/02/2015
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