| The Salvation Army White Shield Center | |
|
2640 Nw Alexandra Ave Portland OR 97210-1289 | |
| (503) 239-1248 | |
| (503) 239-1252 |
| Full Name | The Salvation Army White Shield Center |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2640 Nw Alexandra Ave, Portland, Oregon |
| Authorized Official Name and Position | Diane J Brandsma (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5037313961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Salvation Army White Shield Center Po Box 10027 Portland OR 97296-0027 Ph: (503) 239-1248 | The Salvation Army White Shield Center 2640 Nw Alexandra Ave Portland OR 97210-1289 Ph: (503) 239-1248 |
| NPI Number | 1578994646 |
|---|---|
| Provider Enumeration Date | 11/27/2013 |
| Last Update Date | 11/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578994646 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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