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General NPI Number Information
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NPI Number | 1063288975
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Entity Type | Individual
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Provider Name | TERRI UP
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Gender | Female
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 11/22/2025
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Provider Practice Location Address
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Address Line | 10411 NE FOURTH PLAIN BLVD STE 145
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City | VANCOUVER
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State | WA
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Zip | 98662-5755
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Country | US
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Telephone | 360-903-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 10411 NE FOURTH PLAIN BLVD STE 145
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City | VANCOUVER
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State | WA
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Zip | 98662-5755
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Country | US
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Telephone | 360-903-3195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CB61462592
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License Number State | WA
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