Individual
AVERY C POULSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
5136 SW 19TH DR, PORTLAND, OR 97239-2121
(503) 989-6343
Mailing address
5136 SW 19TH DR, PORTLAND, OR 97239-2121
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/01/2025
Last updated
12/01/2025
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