SAMUEL RUSSELL WAGGONER

PORTLAND, OR
NPI1316658974
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR  T-22-1492)
Enumeration Date2022-12-05
Last Update Date2022-12-05
Business Address
SAMUEL RUSSELL WAGGONER
2727 NE FLANDERS ST
PORTLAND, OR 97232-3159
Phone number: 503-238-5203
Mailing Address
SAMUEL RUSSELL WAGGONER
2901 E BURNSIDE ST
PORTLAND, OR 97214-1831
Phone number: 503-238-5203
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