Ethan Bulisco
Ethan Bulisco is a Peer Specialist in Portland, Oregon. Registered with an NPI since 2024.
- In the registry since
- 2024
Practice location Address checks out
5331 S Macadam Ave Ste 287Portland, OR 97239-3849
Phone: (503) 635-3416
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X |
|---|
Record details
| NPI number | 1073355798 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | June 12, 2024 |
| Last updated in NPPES | June 12, 2024 |
| Certification date | June 12, 2024 |
| Mailing address | 5331 S Macadam Ave Ste 287, Portland, OR 97239-3849 |
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