Individual
EMILY ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34480 BRYAN DR, SCAPPOOSE, OR 97056-3402
(503) 410-1247
Mailing address
34480 BRYAN DR, SCAPPOOSE, OR 97056-3402
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
ABA-IN-10264920
OR
Other
Enumeration date
12/09/2025
Last updated
12/18/2025
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