Individual
FELICIA AIMI WALLBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19824 SW 72ND AVE STE 102, TUALATIN, OR 97062-8398
(503) 773-8600
Mailing address
13823 NW MILL CREEK DR, PORTLAND, OR 97229-5722
(503) 421-1919
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R-5070
OR
Other
Enumeration date
01/24/2019
Last updated
01/24/2019
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