Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003262049 |
---|---|
Provider Name | Traci Ramirez |
First Address | Mcminnville, OR 97128-3923 |
Second Address | Mcminnville, OR 97128-3923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 12/11/2019 |