Individual
TABITHA UNTALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1525 N HUMBOLDT ST UNIT 101, PORTLAND, OR 97217-3673
(360) 936-7857
Mailing address
1525 N HUMBOLDT ST UNIT 101, PORTLAND, OR 97217-3673
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/16/2025
Last updated
10/16/2025
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