Individual
TESS WOLVERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 S 1ST AVE, CHILOQUIN, OR 97624-9738
(541) 591-5669
Mailing address
140 S 1ST AVE, CHILOQUIN, OR 97624-9738
(541) 591-5669
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
10211426
OR
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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