Individual
MIRANDA M BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2701 NW VAUGHN ST, PORTLAND, OR 97210-5311
(503) 721-6800
Mailing address
5246 N EMERSON DR, PORTLAND, OR 97217-4112
(503) 913-0507
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7238
OR
Other
Enumeration date
08/01/2007
Last updated
12/29/2021
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