Healthcare Provider Details

I. General information

NPI: 1558226654
Provider Name (Legal Business Name): RETA JEAN ROMERO CADC-R T-24-4095
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12540 SW MAIN ST
TIGARD OR
97223-6198
US

IV. Provider business mailing address

879 NE FIELDCREST WAY APT T310
HILLSBORO OR
97006-7796
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-9995
  • Fax:
Mailing address:
  • Phone: 503-969-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-24-4095
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: