Provider Demographics
NPI:1043350747
Name:MOORE, TASHA ANN (QMHA)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:ANN
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7112 NE 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3836
Mailing Address - Country:US
Mailing Address - Phone:360-566-5065
Mailing Address - Fax:
Practice Address - Street 1:707 NW EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3517
Practice Address - Country:US
Practice Address - Phone:503-222-4906
Practice Address - Fax:503-222-3215
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator