Healthcare Provider Details

I. General information

NPI: 1447660725
Provider Name (Legal Business Name): TAMARA MONIC SIPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 NE 8TH ST STE 200
GRESHAM OR
97030-5746
US

IV. Provider business mailing address

PO BOX 15623
TAMPA FL
33684-5623
US

V. Phone/Fax

Practice location:
  • Phone: 971-421-8696
  • Fax: 503-328-8094
Mailing address:
  • Phone: 858-652-1211
  • Fax: 503-328-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR9023
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: