Healthcare Provider Details

I. General information

NPI: 1104775873
Provider Name (Legal Business Name): WILDFLOWER BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56249 BUFFLEHEAD RD
BEND OR
97707-2102
US

IV. Provider business mailing address

56249 BUFFLEHEAD RD
BEND OR
97707-2102
US

V. Phone/Fax

Practice location:
  • Phone: 458-600-8730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN RUTH REED
Title or Position: OWNER, BCBA
Credential: BCBA, LBA, MA
Phone: 610-306-7054