Most Relevant Information
Provider Data
| NPI Number: | 1003445875 |
| Provider Name: | SARAH SUSAN TUCKER CRM |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: | 19-CRM-275 |
Most Important Dates
| Enumeration Date: | 04/03/2020 |
| Last Updated: | 04/03/2020 |
Provider Practice Location
155 S EMPIRE BLVD
COOS BAY
OR
974203374
Practice Location Phone/Fax
| Phone: | 5417563111 |
| Fax: | 5417562111 |
Provider Mailing Location
1942 SHERIDAN AVE
NORTH BEND
OR
974593416
Provider Mailing Phone/Fax
| Phone: | 5417563111 |
| Fax: | 5417562111 |