Individual
TRACEY WOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15225 SE 82ND DR, CLACKAMAS, OR 97015-7674
(971) 413-3461
Mailing address
PO BOX 3308, CLACKAMAS, OR 97015-3308
(971) 413-3461
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-010171724
OR
Other
Enumeration date
05/26/2018
Last updated
05/26/2018
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