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1730898404
RYAN GLEN GRISSOM
PORTLAND, OR
NPI
1730898404
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2022-11-21
Last Update Date
2022-11-21
Business Address
RYAN GLEN GRISSOM
12511 SE RAYMOND ST
PORTLAND, OR 97236-3931
Phone number: 503-761-2580
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Mailing Address
RYAN GLEN GRISSOM
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 541-858-8170
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