Individual
IZETTA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
(503) 331-6553
Mailing address
3154 SE SALMON ST, PORTLAND, OR 97214-4142
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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