Graduated: 2012
NPI: 1851654891
Practice Locations (4)
LEGACY CLINICS LLC
24800 SE STARK ST
GRESHAM, OR 970303378
5034138988
PROVIDENCE HEALTH AND SERVICES OREGON
10150 SE 32ND AVE
MILWAUKIE, OR 972226516
5035133613
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 240
PORTLAND, OR 972132981
5032156480
PROVIDENCE HEALTH AND SERVICES OREGON
9205 SW BARNES RD
PORTLAND, OR 972256603
Source: CMS National Downloadable File, September 2026.