Individual
MELISSA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7110 SW FIR LOOP STE 160, TIGARD, OR 97223-8031
(971) 301-3994
Mailing address
7110 SW FIR LOOP STE 160, TIGARD, OR 97223-8031
(971) 301-3994
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
000003289
OR
Other
Enumeration date
03/11/2019
Last updated
03/11/2019
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