Individual
REBECCA STRACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1405 NE BROADWAY ST # 200, PORTLAND, OR 97232-1497
(503) 583-3655
Mailing address
1405 NE BROADWAY ST # 200, PORTLAND, OR 97232-1497
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20078
OR
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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