Individual
AUDELIA DECOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-1793
(503) 418-5516
Mailing address
1154 NW 99TH AVE, PORTLAND, OR 97229-6311
(503) 418-1793
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
11/13/2007
Last updated
12/18/2015
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