Provider Demographics
NPI:1215533641
Name:TOMBAUGH DINGES, KARLIE IREENE (N/A)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:IREENE
Last Name:TOMBAUGH DINGES
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9087 SW CEDARCREST ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6822
Mailing Address - Country:US
Mailing Address - Phone:707-396-0853
Mailing Address - Fax:
Practice Address - Street 1:9115 SW OLESON RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6875
Practice Address - Country:US
Practice Address - Phone:707-396-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician