Individual
CHAD LEWIS MENICOSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13541 SE MARKET ST, PORTLAND, OR 97233-1752
(503) 258-9734
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
372600000X
Adult Companion
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/13/2020
Last updated
04/06/2021
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