Provider Demographics
NPI:1184458945
Name:RACKLIN, CRISTINA RENATA (MA)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:RENATA
Last Name:RACKLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:REYNI
Other - Middle Name:
Other - Last Name:RACKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4019 SE SALMON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4434
Mailing Address - Country:US
Mailing Address - Phone:510-517-1431
Mailing Address - Fax:
Practice Address - Street 1:1904 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1146
Practice Address - Country:US
Practice Address - Phone:503-517-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor