Healthcare Provider Details

I. General information

NPI: 1336900281
Provider Name (Legal Business Name): TIFFANY RIVARD-ROBBINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SW 20TH ST
PENDLETON OR
97801-1869
US

IV. Provider business mailing address

110 SW 20TH ST
PENDLETON OR
97801-1869
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-8261
  • Fax: 541-429-8691
Mailing address:
  • Phone: 541-429-8261
  • Fax: 541-429-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1399953
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: