Individual
DENISE BROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 NE STAFFORD ST, PORTLAND, OR 97211-2241
(503) 875-6472
Mailing address
25 NE STAFFORD ST, PORTLAND, OR 97211-2241
(503) 875-6472
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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