Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1179 | OR |
NPI | 1003029364 |
---|---|
Provider Name | Mr. Robert Lee Marrs |
First Address | Tigard, OR 97223-8665 |
Second Address | Tigard, OR 97223-8356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 13/07/2017 |