Individual
PETER THOMAS CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7621 N PORTSMOUTH AVE, PORTLAND, OR 97203-5953
(503) 240-7599
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OR
Other
Enumeration date
08/14/2012
Last updated
01/14/2020
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