Individual
MR. JORDAN ISAIAH PANTHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 758-5900
Mailing address
520 MAPLE ST, AUMSVILLE, OR 97325-8954
(503) 510-7872
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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