Most Relevant Information
Provider Data
| NPI Number: | 1003479296 |
| Provider Name: | ALYSSA J DISTOR |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/15/2019 |
| Last Updated: | 04/15/2019 |
Provider Practice Location
2020 SE POWELL BLVD
PORTLAND
OR
972022345
Practice Location Phone/Fax
| Phone: | 3102599136 |
| Fax: |
Provider Mailing Location
2020 SE POWELL BLVD
PORTLAND
OR
972022345
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |