Individual
JERRICA FASY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4724 SW MACADAM AVE, PORTLAND, OR 97239-9701
(503) 235-3122
Mailing address
2700 W POWELL BLVD, APT O2114, GRESHAM, OR 97030-6509
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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