Individual
CRYSTAL ELIZABETH KYANKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9115 SW OLESON RD STE 100, PORTLAND, OR 97223-6876
(971) 236-0915
Mailing address
1585 SW TEGART AVE, GRESHAM, OR 97080-9762
(512) 400-5436
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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