Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | OR |
NPI | 1023626470 |
---|---|
Provider Name | Emma Jayme Jordan |
First Address | Portland, OR 97215-1737 |
Second Address | Portland, OR 97215-1737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 21/07/2020 |