Individual
HEATHER GRACE DEPOLITTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
313 NE IVY ST, PORTLAND, OR 97212-2089
(503) 232-1099
Mailing address
313 NE IVY ST, PORTLAND, OR 97212-2089
(503) 236-2129
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
201042698RN
OR
163W00000X
Registered Nurse
Primary
201042698RN
OR
Other
Enumeration date
06/12/2011
Last updated
05/31/2016
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