Individual
ETHAN J NEWCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
1438 SE DIVISION ST, PORTLAND, OR 97202-1140
(503) 548-0346
(503) 232-5959
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000104645
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500795004
—
OR
Enumeration date
10/14/2020
Last updated
08/26/2021
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