Provider Demographics
NPI:1861850737
Name:RIECKMANN, TRACI (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:
Last Name:RIECKMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 SW RIVER PKWY
Mailing Address - Street 2:SUITE 2012
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4553
Mailing Address - Country:US
Mailing Address - Phone:503-577-3414
Mailing Address - Fax:
Practice Address - Street 1:2925 NE 53RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2437
Practice Address - Country:US
Practice Address - Phone:503-577-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling