Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1154868396 |
---|---|
Provider Name | Gabriela Gonzalez |
First Address | Portland, OR 97202-3371 |
Second Address | Portland, OR 97202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2017 |
Last Update Date | 26/01/2017 |