Individual
MR. GLEN ALLEN SUCHANEK I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCI, CRM
Contact information
Practice address
3811 SE CONCORD RD, OAK GROVE, OR 97267-3911
(971) 269-6812
(503) 208-3186
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(971) 269-6812
(503) 208-3186
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-07-04
OR
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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