Individual
KEETA HARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 E 3RD ST, THE DALLES, OR 97058-2562
(541) 298-2101
Mailing address
401 E 3RD ST, THE DALLES, OR 97058-2562
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
10181767
OR
Other
Enumeration date
02/24/2017
Last updated
02/24/2017
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