Individual
CECILIA KOUKOUMANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17727 E BURNSIDE ST, PORTLAND, OR 97233-4803
(503) 215-7826
Mailing address
17727 E BURNSIDE ST, PORTLAND, OR 97233-4803
(503) 215-7826
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
A4887
OR
1041C0700X
Clinical Social Worker
Primary
L10321
OR
Other
Enumeration date
10/11/2017
Last updated
10/08/2020
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