Individual
TATE ROSEBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1675 SW MARLOW AVENUE, SUITE 200, PORTLAND, OR 97225
(971) 248-2395
Mailing address
14800 NW CORNELL RD APT 6E, PORTLAND, OR 97229
(707) 775-7511
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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