person
Samuel Russell Waggoner
Addiction (Substance Use Disorder) Counselor in Portland, Oregon
NPI 1316658974

Samuel Russell Waggoner is an Addiction (Substance Use Disorder) Counselor based in Portland, OR and is specialized in Addiction (Substance Use Disorder). Samuel Russell Waggoner practices in Portland, OR. The NPI Number for Samuel Russell Waggoner is 1316658974 and holds a License No. T-22-1492 (Oregon).

The current practice location address for Samuel Russell Waggoner is 2727 Ne Flanders St, Portland, OR and can be reached out via phone at 503-238-5203.

Location: 2727 Ne Flanders St, Portland, OR, 97214-1831
person
Provider Profile Details
NPI Number
1316658974
Provider Name
Samuel Russell Waggoner
Credential
Provider Entity Type
Individual
Gender
Male
Address
2727 Ne Flanders St, Portland, OR, 97214-1831
Phone Number
503-238-5203
Fax Number
Provider Enumeration Date
12/05/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
2727 Ne Flanders St
City
State
Zip
97232-3159
Phone Number
503-238-5203
Fax Number
person
Provider Business Mailing Address Details
Address
2727 Ne Flanders St
City
State
Zip
97232-3159
Phone Number
503-238-5203
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
T-22-1492 (Oregon)
Definition
Definition to come...
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