Individual
JORDAN K SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
912 NE KELLY AVE STE 100, GRESHAM, OR 97030-5631
(503) 912-5502
Mailing address
912 NE KELLY AVE STE 100, GRESHAM, OR 97030-5631
(503) 912-5502
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OR
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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