Individual
KATHRYN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2120 SW JEFFERSON ST, B200, PORTLAND, OR 97201-7727
(503) 244-4083
Mailing address
2120 SW JEFFERSON ST, B200, PORTLAND, OR 97201-7727
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/14/2016
Last updated
12/14/2016
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