Individual
SAMUEL ST. JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-QMHA-I-01704
QMHA
OR
Enumeration date
06/26/2018
Last updated
09/10/2019
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