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General NPI Number Information
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NPI Number | 1316879554
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Entity Type | Individual
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Provider Name | TRISTAN KACZMAREK
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Gender | Male
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 10700 SW BEAVERTON HILLSDALE HWY STE 546
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City | BEAVERTON
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State | OR
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Zip | 97005-4739
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Country | US
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Telephone | 971-459-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 6875 SW NYBERG ST APT L104
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City | TUALATIN
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State | OR
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Zip | 97062-8245
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Country | US
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Telephone | 541-408-0518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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