Individual
DEJA SVASTISALEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
5014 NE 15TH AVE, PORTLAND, OR 97211-4406
(503) 444-8214
Mailing address
PO BOX 20127, PORTLAND, OR 97294-0127
(503) 444-8214
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OR
Other
Enumeration date
06/20/2023
Last updated
01/23/2024
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