Individual
ALLISON WHITESIDE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
403 SW DENNIS AVE, HILLSBORO, OR 97123-3928
(503) 640-3803
(503) 640-3805
Mailing address
9380 NE WORDEN HILL RD, DUNDEE, OR 97115-9146
(503) 538-9821
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4588
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276348
—
OR
01
—
8383510000
BLUE CROSS BLUE SHIELD
OR
Enumeration date
12/15/2005
Last updated
07/08/2007
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