Individual
AMANDA KUBISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
209 SW 4TH AVE STE 520, PORTLAND, OR 97204-1825
(503) 988-2282
Mailing address
1019 N WINCHELL ST, PORTLAND, OR 97217-1145
(971) 706-4667
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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