Individual
ANDREW GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
509 NE ALBERTA ST, PORTLAND, OR 97211-3976
(503) 249-7767
Mailing address
6023 NE WASCO ST, PORTLAND, OR 97213-4237
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
12/06/2006
Last updated
10/29/2007
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