Healthcare Provider Details

I. General information

NPI: 1710761663
Provider Name (Legal Business Name): TIFFANY L WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 NE MAUZEY CT
HILLSBORO OR
97124-9092
US

IV. Provider business mailing address

1500 NW BETHANY BLVD STE 320
BEAVERTON OR
97006-5238
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9531
  • Fax:
Mailing address:
  • Phone: 326-050-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: