Individual
MS. SHERRY DENISE BOHANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2701 NW VAUGHN ST STE 140, PORTLAND, OR 97210-5344
(503) 499-5200
Mailing address
802 SE 47TH AVE, PORTLAND, OR 97215-1717
(503) 499-5200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2068
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
387007
KAISER PERMANENTE
OR
Enumeration date
12/22/2011
Last updated
01/18/2012
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