Healthcare Provider Details

I. General information

NPI: 1104668623
Provider Name (Legal Business Name): SYNTHIA DENICE TONEY M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SOUTHWEST SALMON STREET 11TH FLOOR
PORTLAND OR
97204
US

IV. Provider business mailing address

25141 SPRINGER RD
SWEET HOME OR
97386-9622
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 541-971-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85169
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: