Individual
JERRAY ANTHONY BRANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS QMHA
Contact information
Practice address
131 NE 102ND AVE, PORTLAND, OR 97220-4167
(503) 253-6754
(503) 251-1344
Mailing address
4715 NE 103RD AVE, PORTLAND, OR 97220-3343
(503) 309-7071
(503) 493-1635
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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