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Individual

MARIAH LYNN SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
10700 SW BEAVERTON HILLSDALE HWY STE 11, BEAVERTON, OR 97005-3035
(503) 641-1475
Mailing address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
OR
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
02/18/2020
Last updated
12/07/2021
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