Individual
LAQUENTA DENISE KIRBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1435 SE 122ND AVE, PORTLAND, OR 97233-1204
(702) 624-7297
Mailing address
1435 SE 122ND AVE, PORTLAND, OR 97233-1204
(702) 624-7297
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
670370-94
OR
Other
Enumeration date
05/12/2010
Last updated
05/12/2010
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