Healthcare Provider Details

I. General information

NPI: 1578088043
Provider Name (Legal Business Name): MARISSA PALMER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA DEANE BCBA

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW 167TH PL STE 240
BEAVERTON OR
97006-4872
US

IV. Provider business mailing address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone: 510-268-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10185925
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: