Individual
KIMBERLY HOOSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5805 SE 15TH DR, GRESHAM, OR 97080-2984
(503) 984-6191
Mailing address
270 NE 181ST AVE, PORTLAND, OR 97230-6663
(503) 669-1966
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
19701
OR
Other
Enumeration date
02/24/2014
Last updated
02/24/2014
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