Individual
CODY WHITTAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9353 SE ALANSA DR STE C, CLACKAMAS, OR 97015-8579
(503) 867-2253
Mailing address
9353 SE ALANSA DR STE C, CLACKAMAS, OR 97015-8579
(503) 867-2253
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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