Individual
REBECCA SOUTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10373 NE HANCOCK ST, PORTLAND, OR 97220-3873
(503) 253-6754
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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