Individual
MRS. HEATHER MARIE MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
2330 NE SISKIYOU ST, PORTLAND, OR 97212-2471
(503) 528-0757
Mailing address
1530 SE 140TH AVE, PORTLAND, OR 97233-2315
(503) 528-0757
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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