Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1043754963 |
---|---|
Provider Name | Tess Wood |
First Address | Portland, OR 97202-3371 |
Second Address | Corvallis, OR 97330-9695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 12/12/2016 |