Individual
MARKUS DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10300 SW EASTRIDGE ST, PORTLAND, OR 97225-5004
(503) 944-5000
Mailing address
10300 SW EASTRIDGE ST, PORTLAND, OR 97225-5004
(503) 944-5000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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