Individual
TRACY JEAN BUCKENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
10300 SW GREENBURG RD, ONE LINCOLN CENTER STE 410, PORTLAND, OR 97223-5410
(503) 517-8555
Mailing address
7735 SW 165TH AVE, BEAVERTON, OR 97007-5856
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
012774
OR
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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