Individual
MS. ALEXA IVY POPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10031 NE CAMPAIGN ST, PORTLAND, OR 97220-3535
(971) 269-5776
Mailing address
4048 NE 122ND AVE OFC, PORTLAND, OR 97230-1335
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A952216
OHP
OR
Enumeration date
09/02/2019
Last updated
09/02/2019
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