Graduated: 2002
NPI: 1992798060
Practice Locations (3)
LEGACY CLINICS LLC
1130 NW 22ND AVE, SUITE 220
PORTLAND, OR 972102969
5034138988
LEGACY CLINICS LLC
2801 N GANTENBEIN AVE
PORTLAND, OR 972271623
5034131122
SALEM HEALTH
665 WINTER ST SE
SALEM, OR 973013934
5035615200
Source: CMS National Downloadable File, September 2026.