Individual
CARLY JOANNA THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 255-4205
(503) 261-0988
Mailing address
3921 SE SALMON ST, PORTLAND, OR 97214-4432
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/26/2007
Last updated
09/26/2007
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