Individual
MONTGOMERY GRANT BASSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5208 NE 122ND AVE, PORTLAND, OR 97230-1074
(503) 256-6500
Mailing address
5208 NE 122ND AVE, PORTLAND, OR 97230-1074
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
013472
OR
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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