Individual
BRANDY FORKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 335-8125
Mailing address
1637 NE 231ST CT, WOOD VILLAGE, OR 97060-2819
(503) 928-0029
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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