Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 106S00000X | Behavior Technician |
NPI | 1003271677 |
---|---|
Provider Name | Stacey Meads |
First Address | Portland, OR 97239-3939 |
Second Address | Portland, OR 97239-3939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2015 |
Last Update Date | 19/03/2019 |