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General NPI Number Information
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NPI Number | 1699205773
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Entity Type | Organization
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Legal Business Name | CEMENTED ROSE THERAPEUTICS, LLC
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 4110 NE 122ND AVE STE 115
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City | PORTLAND
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State | OR
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Zip | 97230-1384
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Country | US
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Telephone | 971-227-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 4110 NE 122ND AVE STE 115
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City | PORTLAND
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State | OR
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Zip | 97230-1384
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Country | US
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Telephone | 971-227-3553
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH DIRECTOR
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Name | SHARNISSA T SECRETT
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Credential |
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Telephone | 971-227-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L6941
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License Number State | OR
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