Individual
ALICIA ROGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, MFT INTERN
Contact information
Practice address
4815 NE 30TH AVE, PORTLAND, OR 97211-7005
(503) 558-5968
Mailing address
4815 NE 30TH AVE, PORTLAND, OR 97211-7005
(503) 558-5968
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
R4192
OR
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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