Individual
DENISE FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7455 SW BEVELAND RD, TIGARD, OR 97223-8610
(503) 233-5405
(503) 233-2694
Mailing address
7455 SW BEVELAND RD, PORTLAND, OR 97223-8610
(503) 624-2600
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164936
MEDICARE GROUP
OR
Enumeration date
02/18/2013
Last updated
02/18/2013
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