Individual
BONNIE BELKNAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
(541) 858-8167
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
OR
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861857880
—
OR
Enumeration date
12/17/2015
Last updated
07/21/2022
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