Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | L7439 | OR |
NPI | 1003194366 |
---|---|
Provider Name | Glykeria Manis |
First Address | Hillsboro, OR 97006-6951 |
Second Address | Portland, OR 97225-6646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 28/12/2021 |