Individual
MS. SUSAN JEAN BLACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
3034 NE M L KING BLVD, PORTLAND, OR 97212-3053
(503) 283-3763
Mailing address
2523 N WATTS ST, PORTLAND, OR 97217-6367
(503) 286-4210
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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