Organization
PEGGY THOMPSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PEGGY THOMPSON LCSW (LICENSED CLINICAL SOCIAL WORKER)
(503) 575-0859
Entity
Organization
Contact information
Practice address
1305 NE FREMONT ST, PORTLAND, OR 97212-2218
(503) 575-0859
Mailing address
PO BOX 83574, PORTLAND, OR 97283-0574
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
3662
OR
305R00000X
Preferred Provider Organization
Primary
3662
OR
Other
Enumeration date
03/25/2011
Last updated
03/25/2011
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