Individual
AUTUMN BOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
727 W BURNSIDE ST, PORTLAND, OR 97209-3514
(971) 271-6073
(503) 228-4618
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
(503) 228-4618
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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