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Individual

ROBERTA JEANNE GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
QMHA

Contact information

Practice address
7621 N PORTSMOUTH AVE, PORTLAND, OR 97203-5953
(503) 240-7599
(503) 240-8066
Mailing address
617 NE 91ST AVE, VANCOUVER, WA 98664-3220
(360) 944-0047

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
01/22/2007
Last updated
07/08/2007
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