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1710660956
LIGHT SIDE WELLNESS CO.
PORTLAND, OR
NPI
1710660956
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Entity Type
Organization
Authorized Contact
STEVEN JON KNOTT
Owner
503-773-4673
Organization Subpart ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
Enumeration Date
2023-08-14
Last Update Date
2023-08-14
Business Address
LIGHT SIDE WELLNESS CO.
2175 NW RALEIGH ST STE 110
PORTLAND, OR 97210-2392
Phone number: 503-773-4673
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Mailing Address
LIGHT SIDE WELLNESS CO.
2355 STATE ST STE 101
SALEM, OR 97301-4541
Phone number: 503-773-4673
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