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1316437189
JONATHON BROADWATER
PORTLAND, OR
NPI
1316437189
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-05-16
Last Update Date
2018-05-16
Business Address
JONATHON BROADWATER
6601 NE 78TH CT STE A3
PORTLAND, OR 97218-2823
Phone number: 503-252-3949
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Mailing Address
JONATHON BROADWATER
6601 NE 78TH CT STE A3
PORTLAND, OR 97218-2823
Phone number: 503-252-3949
Copy
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