Individual
ALISA WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18911 PORTLAND AVE, GLADSTONE, OR 97027-1630
(503) 722-6801
Mailing address
1100 S EASTERN AVE, 2122, LAS VEGAS, NV 89052
(702) 557-9510
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
Primary
L7529
OR
Other
Enumeration date
03/31/2011
Last updated
10/30/2017
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