Individual
KELLY STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
6195 N MINNESOTA AVE APT 1D, PORTLAND, OR 97217-4788
(971) 317-8615
Mailing address
6195 N MINNESOTA AVE APT 1D, PORTLAND, OR 97217-4788
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/13/2020
Last updated
04/30/2021
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