Individual
ANGELA TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
506 SW 6TH AVE, SUITE 905, PORTLAND, OR 97204-1533
(503) 223-5525
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/15/2011
Last updated
08/15/2011
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