Individual
HEATHER FYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 841-8759
Mailing address
018 SW BOUNDARY CT, PORTLAND, OR 97239-3939
(503) 222-9661
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
09/15/2023
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