Individual
MS. WANDA TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, LMT
Contact information
Practice address
11290 SW 95TH AVE, TIGARD, OR 97223-5362
(503) 293-0888
Mailing address
11290 SW 95TH AVE, TIGARD, OR 97223-5362
(503) 293-0888
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC 0857
OR
Other
Enumeration date
02/27/2010
Last updated
09/07/2021
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