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Individual

DAVID HENDRICKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
BA

Contact information

Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
372600000X
Adult Companion

Other

Enumeration date
04/23/2012
Last updated
11/28/2017
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