Individual
JACQUELINE MARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5457 SW CANYON CT, PORTLAND, OR 97221-2401
(971) 762-4663
Mailing address
5457 SW CANYON CT, PORTLAND, OR 97221-2401
(971) 762-4663
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-23-69440
BACB
OR
01
—
10206474
OREGON BARB RBAI
OR
01
—
RBT-20-113167
BACB
—
Enumeration date
02/27/2020
Last updated
11/13/2023
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