Organization
HEALTH MATTERS NORTHWEST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE COQUILLETTE LCSW (PARTNER)
(971) 404-5174
Entity
Organization
Contact information
Practice address
1312 E BURNSIDE ST, PORTLAND, OR 97214-1424
(971) 404-5174
(360) 597-3706
Mailing address
4442 SE NEHALEM ST, PORTLAND, OR 97206-0952
(971) 404-5174
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3057
OR
133N00000X
Nutritionist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500681940
—
OR
Enumeration date
01/08/2016
Last updated
07/21/2022
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