Individual
MAKENNA ANN MERRISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 STATE ST STE G750, SALEM, OR 97301-7012
(971) 273-7502
Mailing address
931 WINDEMERE DR NW, SALEM, OR 97304-2721
(503) 508-3801
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
A418294
OR
Other
Enumeration date
05/29/2019
Last updated
05/29/2019
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