Individual
JEFF DINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2333 SE 12TH AVE, PORTLAND, OR 97214-5323
(503) 235-0031
Mailing address
PO BOX 2476, PORTLAND, OR 97208-2476
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275967184
YOUTH PROGRESS ASSOCIATION
OR
Enumeration date
11/01/2013
Last updated
11/01/2013
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