Individual
BETHANY LEEANN IMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1550 NE WILLIAMSON BLVD STE 120, BEND, OR 97701-6091
(541) 640-5601
Mailing address
1244 NE 4TH ST APT 5, BEND, OR 97701-4358
(503) 407-8976
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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