Provider Demographics
NPI:1558819342
Name:VON LINSOWE-WILSON, TAMI CHERI
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:CHERI
Last Name:VON LINSOWE-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 SW JEFFERSON ST
Mailing Address - Street 2:APT 111
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6092
Mailing Address - Country:US
Mailing Address - Phone:480-381-1287
Mailing Address - Fax:
Practice Address - Street 1:3720 SW 141ST AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2382
Practice Address - Country:US
Practice Address - Phone:503-352-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health