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NPI Code Detail

MEDICARE: THE ESTUARY CENTER

MEDICARE: THE ESTUARY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265013684
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE ESTUARY CENTER
Provider Business Mailing Address
First Line : 15585 NW BARKTON ST
Second Line :
City : BEAVERTON
State : OR
Zip : 97006-5349
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7475 SW OLESON RD
Second Line :
City : PORTLAND
State : OR
Zip : 97223-7474
Country : US
Telephone Number : 971-804-0276
Fax Number : 503-296-2972
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. KELLEE ANN HERNANDEZ
Credential :
Telephone Number : 971-804-0276
Provider Enumeration Date : 04/16/2021
Last Update Date : 08/12/2025

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Directions to “THE ESTUARY CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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