Individual
HALEY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10714 NE GLISAN ST, PORTLAND, OR 97220-4046
(503) 256-2453
Mailing address
12628 SW 172ND TER APT 205, BEAVERTON, OR 97007-2087
(714) 353-7516
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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