Individual
JONATHAN BOISVERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 546-6377
Mailing address
214 N STAFFORD ST, PORTLAND, OR 97217-1542
(262) 215-1640
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/26/2019
Last updated
10/17/2019
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