Individual
MR. MARK EDWARD HOLDERBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.W., L.C.S.W.
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
(503) 666-4047
Mailing address
14978 SW EMERALD CT, BEAVERTON, OR 97007-8560
(503) 666-6575
(503) 666-4047
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3497
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041C0700X CLINICAL
—
OR
Enumeration date
03/22/2007
Last updated
07/09/2007
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