Individual
GINA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 E 2ND ST, THE DALLES, OR 97058-2107
(541) 298-2101
Mailing address
309 E 2ND ST, THE DALLES, OR 97058-2107
(541) 298-2101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10179260
OR
Other
Enumeration date
07/28/2016
Last updated
10/18/2016
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