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1174340525
BEN RUSSELL
PORTLAND, OR
NPI
1174340525
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
(Licence: OR 24-CRM-3712)
Enumeration Date
2024-09-25
Last Update Date
2024-09-25
Business Address
BEN RUSSELL
80 SE MADISON ST
PORTLAND, OR 97214-4527
Phone number: 916-584-5821
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Mailing Address
BEN RUSSELL
620 SE 146TH AVE
PORTLAND, OR 97233-2507
Phone number: 971-380-0984
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