Individual
MRS. CHRISTINE ALEXANDRA DETROIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
821 SAGINAW ST S, SALEM, OR 97302-4121
(503) 589-4046
(503) 480-0484
Mailing address
821 SAGINAW ST S, SALEM, OR 97302-4121
(503) 589-4046
(503) 480-0484
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
23-QMHA-II-000119
OR
222Q00000X
Developmental Therapist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740618982
—
OR
Enumeration date
10/25/2013
Last updated
04/02/2024
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