Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 06-11-73 | OR |
NPI | 1003030610 |
---|---|
Provider Name | Laura Ann Allen |
First Address | Tigard, OR 97223-5492 |
Second Address | Tigard, OR 97223-5492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MCD# 500701970 | (05) | OR |