Individual
MRS. TRACI LYNN COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 228-7134
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/24/2008
Last updated
06/19/2008
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