Individual
KIMBERLY FORREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Mailing address
19402 SE STARK ST, # 5, PORTLAND, OR 97233-5760
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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