Individual
UNKNOWN GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBAI
Contact information
Practice address
18765 SW BOONES FERRY RD STE 100, TUALATIN, OR 97062-8607
(503) 673-1248
Mailing address
12920 SW TAPADERA ST, BEAVERTON, OR 97008-7234
(503) 380-0247
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10246206
OR
Other
Enumeration date
06/20/2024
Last updated
08/05/2024
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