Individual
NOLAN LEASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3530 SE 88TH AVE, PORTLAND, OR 97266-2396
(503) 772-4335
(503) 772-4337
Mailing address
4357 N WILLIAMS AVE APT 512, PORTLAND, OR 97217-2980
(916) 340-5158
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/10/2023
Last updated
10/10/2023
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