Individual
JORDAN LITTLE GABILONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7632 SE FLAVEL ST, PORTLAND, OR 97206-7813
(503) 467-0581
Mailing address
6300 E BURNSIDE ST APT 1, PORTLAND, OR 97215-1300
(541) 961-1317
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0177
JANUS YOUTH PROGRAM
OR
Enumeration date
06/30/2017
Last updated
06/30/2017
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