Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003180373 |
---|---|
Provider Name | Mrs. Nalini Kuruppu |
First Address | Portland, OR 97217-4363 |
Second Address | Portland, OR 97217-4363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2012 |
Last Update Date | 01/09/2020 |