Individual
MS. THEODORA ELIZABETH BETZVOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1675 SW MARLOW AVE, PORTLAND, OR 97225-5104
(866) 523-4268
Mailing address
1675 SW MARLOW AVE, PORTLAND, OR 97225-5104
(866) 523-4268
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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