Individual
ALLISON RAE SUPNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
14025 SW FARMINGTON RD, SUITE 160, BEAVERTON, OR 97005-2512
(503) 258-4511
Mailing address
14025 SW FARMINGTON RD, SUITE 160, BEAVERTON, OR 97005-2512
(503) 807-3083
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
1041S0200X
School Social Worker
—
—
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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