Individual
MARISA JEAN MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1245 SE 122ND AVE, PORTLAND, OR 97233-1201
(503) 290-8816
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 290-8816
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/07/2008
Last updated
07/10/2012
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