Most Relevant Information
Provider Data
| NPI Number: | 1003302621 |
| Provider Name: | MATTHEW SPRAGUE KIDDER |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/06/2018 |
| Last Updated: | 01/26/2024 |
Provider Practice Location
7330 SE 42ND AVE
PORTLAND
OR
972068404
Practice Location Phone/Fax
| Phone: | 5033582891 |
| Fax: |
Provider Mailing Location
7330 SE 42ND AVE
PORTLAND
OR
972068404
Provider Mailing Phone/Fax
| Phone: | 5033582891 |
| Fax: |