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General NPI Number Information
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NPI Number | 1265268197
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Entity Type | Individual
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Provider Name | YANA PONOMAROVA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 555 SE 99TH AVE
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City | PORTLAND
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State | OR
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Zip | 97216-2449
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Country | US
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Telephone | 971-271-6512
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Fax |
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Provider Business Mailing Address
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Address Line | 14101 SE SUMMERFIELD LOOP
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-5394
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Country | US
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Telephone | 971-340-7817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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