Individual
MR. ROGER DALE CLOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
254 N 1ST AVE, HILLSBORO, OR 97124-3003
(503) 847-0124
Mailing address
254 N 1ST AVE, HILLSBORO, OR 97124-3003
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12CRM031
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
81-0634495
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81-0634495
—
OR
Enumeration date
03/18/2015
Last updated
03/18/2015
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