Individual
SUZANNE MICHELLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 515-5566
(503) 261-0988
Mailing address
830 NE SOUTH SHORE RD, PORTLAND, OR 97211-1132
(503) 302-9258
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SM1219
OR
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
SM1219
OR
Other
Enumeration date
08/14/2008
Last updated
07/29/2010
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