Individual
ANDREA CODY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7455 SW BEVELAND RD, TIGARD, OR 97223-8610
(503) 624-2600
Mailing address
16210 PARKER RD, LAKE OSWEGO, OR 97035-4038
(503) 675-2981
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L1143
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
10/03/2006
Last updated
07/09/2007
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