Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | OR |
NPI | 1003166620 |
---|---|
Provider Name | Suzanne Merritt Bilderback |
First Address | Portland, OR 97202-3371 |
Second Address | Corvallis, OR 97330-9695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 11/09/2012 |