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1619521887
JONATHAN BOISVERT
PORTLAND, OR
NPI
1619521887
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-07-26
Last Update Date
2019-10-17
Business Address
JONATHAN BOISVERT
6200 SE KING RD
PORTLAND, OR 97222-2891
Phone number: 503-546-6377
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Mailing Address
JONATHAN BOISVERT
214 N STAFFORD ST
PORTLAND, OR 97217-1542
Phone number: 262-215-1640
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