Individual
GRETA GIDLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 896-0962
Mailing address
PO BOX 33596, PORTLAND, OR 97292-3596
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
08-12-17
OR
Other
Enumeration date
01/26/2011
Last updated
01/26/2011
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