Individual
GRACE E HABURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3494 LIBERTY RD S, SALEM, OR 97302-4607
(972) 304-0660
Mailing address
8570 MCCAMMON LN SE, SALEM, OR 97317-8954
(971) 283-4951
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/28/2019
Last updated
07/28/2019
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