Most Relevant Information
Provider Data
| NPI Number: | 1003342155 |
| Provider Name: | BRENDA BONILLA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 97763 |
Most Important Dates
| Enumeration Date: | 05/11/2017 |
| Last Updated: | 10/15/2024 |
Provider Practice Location
3181 SW SAM JACKSON PARK RD
PORTLAND
OR
972393011
Practice Location Phone/Fax
| Phone: | 5034942273 |
| Fax: | 5034946023 |
Provider Mailing Location
1400 SW 5TH AVE STE 500
PORTLAND
OR
972015537
Provider Mailing Phone/Fax
| Phone: | 8666176855 |
| Fax: | 5033468015 |