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1942706106
SHANE JACKSON BASS
CLACKAMAS, OR
NPI
1942706106
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103K00000X Behavior Analyst
Additional Taxonomies
103K00000X Behavior Analyst
Enumeration Date
2018-04-04
Last Update Date
2018-04-04
Business Address
Mr. SHANE JACKSON BASS
12901 SE 97TH AVE STE 180
CLACKAMAS, OR 97015-7903
Phone number: 971-206-6337
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Mailing Address
Mr. SHANE JACKSON BASS
16026 NE SANDY BLVD APT 130
PORTLAND, OR 97230-8810
Phone number: 360-449-9685
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