Individual
JOHN WILLIAM THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5538 NE 24TH AVE, PORTLAND, OR 97211-6206
(503) 757-0827
Mailing address
5538 NE 24TH AVE, PORTLAND, OR 97211-6206
(503) 757-0827
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
320800000X
OR
Other
Enumeration date
10/12/2015
Last updated
10/12/2015
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