Wolleat, Tiffany Dawn

Wolleat, Tiffany Dawn is an individual health care provider with primary practice located at 620 Ne 2Nd St , Gresham OR 97030-7514. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Wolleat, Tiffany Dawn can be contacted via phone (971) 274-3757.

Contact Information

Primary practice address
620 Ne 2Nd St Gresham OR 97030-7514
Phone: (971) 274-3757
Fax: (503) 912-5740
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X THW000106154 Oregon
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 24-03-11057 Oregon
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 24-CRM-II-0221 Oregon

Profile Details

NPI number 1811630361
LBN Legal business name Wolleat, Tiffany Dawn
Credentials CADC I/CRM II/PSS
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2022
Last updated Mar 20th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811630361 NPPES
Oregon MEDICAID 500806711
Oregon MEDICAID 500808225

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