Individual
LEAH BRANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15700 SW GREYSTONE CT, BEAVERTON, OR 97006-6011
(971) 262-9150
Mailing address
15290 SW ROYALTY PKWY, TIGARD, OR 97224-4059
(503) 607-6100
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10211324
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HM101O9A
—
OR
Enumeration date
01/11/2021
Last updated
01/11/2021
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