Most Relevant Information
Provider Data
| NPI Number: | 1003589672 |
| Provider Name: | JORDAN ALEXANDER MORENO |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | B159150 |
Most Important Dates
| Enumeration Date: | 07/29/2021 |
| Last Updated: | 07/29/2021 |
Provider Practice Location
3400 STATE STREET, SUITE G-750 SALEM, OR 97301
SALEM
OR
97301
Practice Location Phone/Fax
| Phone: | 9712737502 |
| Fax: |
Provider Mailing Location
3400 STATE STREET, SUITE G-750 SALEM, OR 97301
SALEM
OR
97301
Provider Mailing Phone/Fax
| Phone: | 9712737502 |
| Fax: |