Individual
JUANITA BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3311 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97212-2086
(503) 676-7371
(503) 430-5403
Mailing address
3311 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97212-2086
(503) 676-7371
(503) 430-5403
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
16-CRM-121
OR
Other
Enumeration date
11/26/2016
Last updated
11/26/2016
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