Individual
JACK PHILIP PORTORSNOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3680 S CEDAR ST, TACOMA, WA 98409-5728
(206) 313-8840
Mailing address
5320 204TH STREET CT E, SPANAWAY, WA 98387-5787
(253) 361-5055
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
CB61440913
WA
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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