Individual
NICOLE STUCKART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4080 REED RD SE STE 150, SALEM, OR 97302-1335
(503) 581-1732
(503) 363-4607
Mailing address
4080 REED RD SE # ATE150, SALEM, OR 97302-1357
(503) 581-1732
(503) 363-4607
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
110255
OR
Other
Enumeration date
11/21/2024
Last updated
11/21/2024
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