Individual
MRS. NICOLE JON CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
3310 SE DIVISION ST, PORTLAND, OR 97202-1457
(971) 235-0388
Mailing address
3310 SE DIVISION ST, PORTLAND, OR 97202-1457
(971) 235-0388
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2658
OR
Other
Enumeration date
03/11/2009
Last updated
03/11/2009
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