Individual
CAROL JO STUART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2188 SW PARK PL, 205, PORTLAND, OR 97205-1100
(503) 827-4800
Mailing address
PO BOX 2607, PORTLAND, OR 97208-2607
(503) 827-4800
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1072
OR
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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