Individual
GWENN TIANA CODY-WALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
819 SE MORRISON ST STE 250, PORTLAND, OR 97214-6315
(503) 230-0518
Mailing address
819 SE MORRISON ST STE 250, PORTLAND, OR 97214-6315
(503) 230-0518
(503) 200-1438
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2018
OR
Other
Enumeration date
07/15/2008
Last updated
04/26/2011
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