Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 103K00000X | OR |
NPI | 1053863548 |
---|---|
Provider Name | Whitney Cordes |
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 | 31/10/2016 |
Last Update Date | 31/10/2016 |