Individual
TYLER WILLIAM BRISTOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
707 NE COUCH ST, PORTLAND, OR 97232-2922
(503) 542-4610
(503) 233-6093
Mailing address
707 NE COUCH ST, PORTLAND, OR 97232-2922
(503) 542-4610
(503) 233-6093
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104100000X
TREATMENT PROGRAM
—
Enumeration date
02/07/2014
Last updated
02/07/2014
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