Individual
MR. SHANE JACKSON BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12901 SE 97TH AVE STE 180, CLACKAMAS, OR 97015-7903
(971) 206-6337
Mailing address
16026 NE SANDY BLVD APT 130, PORTLAND, OR 97230-8810
(360) 449-9685
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
OR
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
04/04/2018
Last updated
04/04/2018
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