Individual
TAGG XIONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
912 NE KELLY AVE STE 100, GRESHAM, OR 97030-5631
(503) 912-5502
Mailing address
912 NE KELLY AVE STE 100, GRESHAM, OR 97030-5631
(503) 912-5502
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10211544
OR
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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