Provider Demographics
NPI:1063004141
Name:HARDY, TUCKER (MSW, CSWA)
Entity Type:Individual
Prefix:
First Name:TUCKER
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1134
Mailing Address - Country:US
Mailing Address - Phone:801-318-7633
Mailing Address - Fax:971-302-6956
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 350
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4737
Practice Address - Country:US
Practice Address - Phone:971-279-2067
Practice Address - Fax:971-302-6956
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA121981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical