Individual
GIANCARLO MARCELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3400 STATE ST STE G750, SALEM, OR 97301-7012
(971) 273-7502
Mailing address
816 LOCKHAVEN DR NE, KEIZER, OR 97303-3748
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
A257918
OR
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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