Individual
ANASTASIA MITSANAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 STATE ST STE G750, SALEM, OR 97301-7012
(971) 273-7502
Mailing address
3400 STATE ST STE G750, SALEM, OR 97301-7012
(971) 273-7502
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
10212956
OR
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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