Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | C1890 | OR |
NPI | 1003029000 |
---|---|
Provider Name | Sabrina Jen Walters |
First Address | Beaverton, OR 97006-4704 |
Second Address | Hillsboro, OR 97124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164936 | (05) | OR |