Individual
MS. TANYA ANNE PRATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2732 NE BROADWAY ST, PORTLAND, OR 97232-1723
(971) 212-5927
(971) 275-1008
Mailing address
2732 NE BROADWAY ST, PORTLAND, OR 97232-1723
(971) 212-5927
(971) 275-1008
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2246
OR
103TC0700X
Clinical Psychologist
PY3359
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
01
—
8999070
PERSONAL MEDICARE
WA
Enumeration date
10/25/2006
Last updated
11/09/2012
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