Individual
TARA BLACKINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
10209 SE DIVISION ST, PORTLAND, OR 97266-1372
(971) 517-7048
(971) 302-7469
Mailing address
PO BOX 16756, PORTLAND, OR 97292-0756
(971) 517-7048
(503) 208-2596
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
16-CRM-196
OR
Other
Enumeration date
10/24/2016
Last updated
11/01/2016
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