Individual
JOCELYN MOORE WAGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2709 SE 71ST AVE, PORTLAND, OR 97206-1124
(503) 470-1484
Mailing address
2709 SE 71ST AVE, PORTLAND, OR 97206-1124
(503) 470-1484
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
10/20/2014
Last updated
10/24/2024
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