Individual
EBONI DEE SAMUELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14355 N BYBEE LAKE CT, PORTLAND, OR 97203-6495
(971) 716-3309
Mailing address
945 NW NAITO PKWY APT 535, PORTLAND, OR 97209-4718
(916) 271-0685
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
OR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/25/2024
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