Most Relevant Information
Provider Data
| NPI Number: | 1003590480 |
| Provider Name: | ASHLEY BARDALES |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/14/2023 |
| Last Updated: | 06/14/2023 |
Provider Practice Location
3036 NE MLK JR BLVD
PORTLAND
OR
972123053
Practice Location Phone/Fax
| Phone: | 5032833763 |
| Fax: | 5037350912 |
Provider Mailing Location
PO BOX 8459
PORTLAND
OR
972078459
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |