Individual
JESSICA DYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C., B.C.B.A.
Contact information
Practice address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(866) 523-4268
Mailing address
5525 N WILLIAMS AVE, PORTLAND, OR 97217-2452
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C3570
OR
103K00000X
Behavior Analyst
Primary
1-15-18041
OR
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
04/07/2015
Last updated
06/07/2022
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