Individual
TIERRA EMMALY KAFEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9115 SW OLESON RD STE 100, PORTLAND, OR 97223-6876
(971) 236-0915
Mailing address
122 INDIGO CT, KELSO, WA 98626-1882
(360) 846-7952
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
KAFELTE005MB
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
912196637
UNITEDHEALTHCARE
WA
Enumeration date
05/27/2019
Last updated
05/27/2019
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