Individual
TIFFANY WILDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
405 NE 5TH ST, GRESHAM, OR 97030-7345
(503) 666-5600
(503) 667-9633
Mailing address
405 NE 5TH ST, GRESHAM, OR 97030-7345
(503) 666-5600
(503) 667-9633
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
13350
OR
Other
Enumeration date
07/07/2010
Last updated
07/07/2010
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