Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003338005 |
---|---|
Provider Name | Bakura Leib-Reiser |
First Address | Portland, OR 97232-2922 |
Second Address | Portland, OR 97206-7813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 11/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0177 | (05) | OR |