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Individual

KOREY THIELEKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
16535 SW TUALATIN VALLEY HWY, BEAVERTON, OR 97003-5143
(503) 649-5651
Mailing address
16535 SW TUALATIN VALLEY HWY, BEAVERTON, OR 97003-5143
(503) 649-5651

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary

Other

Enumeration date
08/10/2023
Last updated
08/10/2023
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