Organization
JOLEEN ROSS, LCSW, CADC I
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOLEEN ROSS (THERAPIST)
(971) 322-4265
Entity
Organization
Contact information
Practice address
1216 NW 21ST AVE, PORTLAND, OR 97209-1609
(971) 322-4265
Mailing address
15119 NW NIGHTSHADE DR, PORTLAND, OR 97229-1573
(971) 322-4265
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
5773
OR
Other
Enumeration date
01/02/2017
Last updated
01/02/2017
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