Individual
ASHLEY TIEGEN-TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12155 SW TOOZE RD, SHERWOOD, OR 97140-8441
(503) 570-0147
Mailing address
7714 SW 45TH AVE #66, PORTLAND, OR 97219
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
ABA-IN-10175214
OR
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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