Individual
OSARETINE AGBONZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 SW SALMON ST FL 11, PORTLAND, OR 97204-2908
(503) 464-7207
Mailing address
121 SW SALMON ST FL 11, PORTLAND, OR 97204-2908
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10213741
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ABA-IN-10213741
INDIVIDUAL
—
Enumeration date
04/14/2021
Last updated
04/14/2021
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