Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ABA-AB-10211437 | OR |
NPI | 1134717333 |
---|---|
Provider Name | Jesse Ray Cronin |
First Address | Portland, OR 97204-2908 |
Second Address | Portland, OR 97204-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2021 |
Last Update Date | 04/01/2021 |