Individual
M. EILEEN HICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6606 SW CAPITOL HWY, PORTLAND, OR 97239-1944
(503) 805-7887
Mailing address
6327 SW CAPITOL HWY STE C, PORTLAND, OR 97239-2190
(503) 805-7887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10514
OR
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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