Individual
MICHELLE L GENDVIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16205 NW BETHANY CT STE 116, BEAVERTON, OR 97006-4687
(971) 312-5459
(503) 747-4210
Mailing address
16205 NW BETHANY CT STE 116, BEAVERTON, OR 97006-4687
(971) 312-5459
(503) 747-4210
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10167350
OR
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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