Individual
MS. BETHESDA SPENCER-CANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
909 N BEECH ST, PORTLAND, OR 97227-1198
(801) 558-5242
Mailing address
909 N BEECH ST UNIT 208, PORTLAND, OR 97227-1260
(801) 558-5242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10228120
OR
Other
Enumeration date
07/19/2017
Last updated
12/12/2024
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