Individual
CONSTANCE JOAN COQUILLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2410 SE 121ST AVE STE 216, PORTLAND, OR 97216-4085
(971) 404-5174
(503) 335-5974
Mailing address
12105 NE 40TH CIR, VANCOUVER, WA 98682-6488
(971) 404-5174
(503) 335-5974
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3057
OR
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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