Individual
SANDRA MEGAN CORNWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
945 NE 165TH AVE, PORTLAND, OR 97230-6148
(971) 409-9113
Mailing address
9205 SE SALMON ST, PORTLAND, OR 97216-2119
(971) 409-9113
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
01/22/2007
Last updated
03/22/2015
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