Graduated: 1984
Offers telehealth
NPI: 1255496709
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES - OREGON
4805 NE GLISAN ST
PORTLAND, OR 972132933
5032151111
5050 NE HOYT ST, SUITE 203
PORTLAND, OR 972132956
5032309224
Source: CMS National Downloadable File, September 2026.