NPI 1710174404

Carly Joanna Thompson

Practitioner Emotionally Disturbed Childrens' Residential Treatment Facility Portland, OR

Practice location

Address: 722 NE 162nd Ave, Portland, OR 97230-5760
Phone: (503) 255-4205
Fax: (503) 261-0988
Mailing address: 3921 SE Salmon St, Portland, OR 97214-4432

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

Other Residential Treatment Facility, Emotionally Disturbed Children providers in Oregon →

Registry record

NPI: 1710174404
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Sep 2007
Record last updated: 26 Sep 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.