Individual
MIRANDA DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12155 SW TOOZE RD, SHERWOOD, OR 97140-8441
(503) 570-0147
Mailing address
12155 SW TOOZE RD, SHERWOOD, OR 97140-8441
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-15-05793
OR
Other
Enumeration date
05/27/2016
Last updated
05/27/2016
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