Individual
LAUREL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14278 SW ALLEN BLVD, BEAVERTON, OR 97005-4405
(503) 305-6262
Mailing address
8060 SW PFAFFLE ST STE 106, TIGARD, OR 97223-8489
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
ABA-IN-10241615
OR
363A00000X
Physician Assistant
Primary
PA22399
OR
Other
Enumeration date
03/07/2024
Last updated
02/18/2025
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