Individual
MARY JEAN BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 NW 9TH ST STE 202, CORVALLIS, OR 97330-6173
(541) 768-5254
Mailing address
815 NW 9TH ST STE 202, CORVALLIS, OR 97330-6173
(541) 768-5254
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2406
OR
Other
Enumeration date
05/04/2012
Last updated
05/04/2012
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