Individual
AUTUMN ELAINE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3632 N TRENTON ST, PORTLAND, OR 97217-7453
(503) 841-6128
Mailing address
5136 NE GLISAN ST, PORTLAND, OR 97213-2940
(971) 563-9873
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OR
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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