Individual
TIFFINY JEANNETTE GRAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 SE 15TH AVE, PORTLAND, OR 97214-2603
(971) 307-7829
Mailing address
520 SE 15TH AVE, PORTLAND, OR 97214-2603
(971) 307-7829
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OR
175T00000X
Peer Specialist
—
OR
251K00000X
Public Health or Welfare Agency
—
OR
Other
Enumeration date
04/16/2024
Last updated
11/19/2024
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