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General NPI Number Information
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NPI Number | 1962380790
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Entity Type | Individual
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Provider Name | KRYSTAL TODERICK M.ED
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Gender |
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 5405 SE WOODWARD ST
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City | PORTLAND
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State | OR
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Zip | 97206-2199
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Country | US
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Telephone | 503-916-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 501 N DIXON ST
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City | PORTLAND
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State | OR
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Zip | 97227-1876
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Country | US
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Telephone |
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 512576
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License Number State | OR
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