Individual
TANGI CELESTE DEFFENDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10373 NE HANCOCK ST STE 200, PORTLAND, OR 97220-3873
(503) 253-6754
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/21/2024
Last updated
11/21/2024
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