Individual
STEPHANIE MARIE HUMIWAT JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 SE 108TH AVE, PORTLAND, OR 97216-3127
(916) 753-9211
Mailing address
415 SE 108TH AVE, PORTLAND, OR 97216-3127
(916) 753-9211
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10227793
OR
Other
Enumeration date
12/09/2022
Last updated
12/09/2022
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