Individual
STEPHEN JACK ECCLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
TRILLIUM CHILDREN'S FARM HOME, 4455 NE HWY 20, CORVALLIS, OR 97330
(541) 757-1852
Mailing address
TRILLIUM CHILDREN'S FARM HOME, 4455 NE HWY 20, CORVALLIS, OR 97330
(541) 757-1852
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/21/2019
Last updated
05/21/2019
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