Individual
KIMBERLY LYNN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2705 E BURNSIDE ST, SUITE 206, PORTLAND, OR 97214-1763
(503) 449-2951
Mailing address
3638 NE 77TH AVE, PORTLAND, OR 97213-6406
(503) 449-2951
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3341
OR
Other
Enumeration date
07/09/2009
Last updated
11/03/2015
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