Individual
MARIEL BAY GRIMORD-ISHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
200 SE 7TH AVE, PORTLAND, OR 97214-1200
(503) 972-9537
Mailing address
8214 N NEWMAN AVE, PORTLAND, OR 97203-3544
(503) 553-9099
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L6323
OR
Other
Enumeration date
07/27/2011
Last updated
03/04/2015
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