Healthcare Provider Details

I. General information

NPI: 1700600442
Provider Name (Legal Business Name): RACHAEL SUSAN NYE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NE KELLY AVE
GRESHAM OR
97030-5629
US

IV. Provider business mailing address

14435 S 48TH ST APT 2138
PHOENIX AZ
85044-6451
US

V. Phone/Fax

Practice location:
  • Phone: 480-608-5210
  • Fax:
Mailing address:
  • Phone: 406-596-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberABA-B-10260793
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: