CLEMENT NISBET WILSON FONSECA

PORTLAND, OR
NPI1124539879
Former NameCLEMENTINE M WILSON
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: OR  L11642)
Enumeration Date2017-10-21
Last Update Date2025-09-02
Business Address
CLEMENT NISBET WILSON FONSECA LCSW
3125B NE HOLLADAY ST
PORTLAND, OR 97232-2504
Phone number: 503-217-4457
Mailing Address
CLEMENT NISBET WILSON FONSECA LCSW
PO BOX 11764
PORTLAND, OR 97211-0764
Phone number: 857-498-0287
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