Individual
SONJA CHARLENE CRISOSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4224 NE HALSEY ST STE 335, PORTLAND, OR 97213-1568
(503) 922-6616
Mailing address
7509 NE PACIFIC ST, PORTLAND, OR 97213-6274
(971) 212-9843
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
L11236
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P4723
—
OR
Enumeration date
03/13/2013
Last updated
02/05/2024
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