Individual
JUDITH LYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA IN HUMAN STUDIES
Contact information
Practice address
4101 NE DIVISION ST, SUITE # 100, GRESHAM, OR 97030-4617
(503) 666-3808
(503) 666-6835
Mailing address
8195 SE POPPY ST, PORTLAND, OR 97267-5358
(503) 989-9225
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/26/2007
Last updated
10/26/2007
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