Individual
TAMERA JESSEN-IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
742 HAWTHORNE AVE NE, SALEM, OR 97301-4675
(503) 559-3555
Mailing address
PO BOX 13459, SALEM, OR 97309-1459
(503) 559-3555
(503) 769-3114
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
109
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023008
—
OR
Enumeration date
06/04/2012
Last updated
06/04/2012
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