Individual
WENDY SUSANNE HUSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1217 NE BURNSIDE RD, SUITE 502, GRESHAM, OR 97030-6722
(503) 492-3910
(503) 492-3905
Mailing address
10114 SE KNIGHT ST, PORTLAND, OR 97266-4414
(971) 506-7237
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10361
OR
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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