Individual
JIMMY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 NW 169TH PL STE C100, BEAVERTON, OR 97006-7362
(503) 747-2587
(503) 746-6323
Mailing address
1800 NW 169TH PL STE C100, BEAVERTON, OR 97006-7362
(503) 747-2587
(503) 746-6323
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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