Individual
REBECCA LEE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10209 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9782
(800) 813-2000
Mailing address
15150 SE ARISTA DR, MILWAUKIE, OR 97267-2651
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-0798039
KAISER PERMANENTE
—
Enumeration date
01/07/2021
Last updated
01/07/2021
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