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Individual

MRS. MISTY TANNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.W.

Contact information

Practice address
3720 SW 141ST AVE, #204, BEAVERTON, OR 97005-2382
(503) 942-1475
Mailing address
7500 SW SCHOLLS FERRY RD, APT A3, BEAVERTON, OR 97008-6573
(503) 641-8641

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
02/23/2007
Last updated
07/08/2007
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