Individual
LUCAS BENJAMIN BOUMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(971) 373-1406
Mailing address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
03/22/2018
Last updated
03/22/2018
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