Individual
KYLIE IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(866) 523-4268
Mailing address
292 COLLEGE ST S APT 11, MONMOUTH, OR 97361-2056
(971) 241-6555
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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