Individual
TISA PICKERING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
308 SW 1ST AVE, PORTLAND, OR 97204-3400
(503) 808-1256
Mailing address
1422 SW HALL ST APT 1, PORTLAND, OR 97201-6117
(503) 381-3471
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
Primary
NO.21-QMHA-R-1548
OR
Other
Enumeration date
09/02/2021
Last updated
06/29/2023
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