Individual
SAM STEWART RICKENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(866) 523-4268
Mailing address
DEPT LA 22763, PASADENA, CA 91185-2763
(541) 380-0771
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/16/2022
Last updated
05/16/2022
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