Healthcare Provider Details

I. General information

NPI: 1366318107
Provider Name (Legal Business Name): NORTHWEST REGIONAL EDUCATION SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14255 SW BRIGADOON CT
BEAVERTON OR
97005-3369
US

IV. Provider business mailing address

14255 SW BRIGADOON CT
BEAVERTON OR
97005-3369
US

V. Phone/Fax

Practice location:
  • Phone: 503-941-8120
  • Fax:
Mailing address:
  • Phone: 503-941-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON TANNLER
Title or Position: DISTRICT NURSE
Credential: RN
Phone: 503-941-8120