MEDICARE: JAFIA RHIANNON KOLSTAD

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1972342418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAFIA RHIANNON KOLSTAD

Provider Business Mailing Address
First Line	:	21990 NE CHINOOK WAY APT A
Second Line	:
City	:	FAIRVIEW
State	:	OR
Zip	:	97024-2631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 SE INTERNATIONAL WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-4660
Country	:	US
Telephone Number	:	503-577-6774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/28/2025

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Directions to “ JAFIA RHIANNON KOLSTAD ” Practice Location

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