Individual
STEPHANIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
945 SE UGLOW AVE, DALLAS, OR 97338-2642
(503) 837-1762
Mailing address
1401 W ELLENDALE AVE UNIT 81, DALLAS, OR 97338-1367
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000109289
OR
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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