Individual
PENNY WEIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 SE WOODWARD ST, PORTLAND, OR 97202-1552
(503) 517-8863
Mailing address
6404 SW 30TH AVE APT 32, PORTLAND, OR 97239-1061
(414) 758-6763
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/09/2008
Last updated
10/09/2008
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