Individual
MR. JAMES MICHAEL ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
PO BOX 505, SEASIDE, OR 97138-0505
(503) 841-7722
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M6016
OR
Other
Enumeration date
11/20/2019
Last updated
11/20/2019
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