Healthcare Provider Details

I. General information

NPI: 1275169799
Provider Name (Legal Business Name): AUTISM PARTNERS (NORTHWEST) INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NW 8TH AVE
PORTLAND OR
97209-3503
US

IV. Provider business mailing address

49 PIER AVE STE B
HERMOSA BEACH CA
90254-3776
US

V. Phone/Fax

Practice location:
  • Phone: 503-447-8770
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON GRAY
Title or Position: DIRECTOR
Credential: BCBA
Phone: 503-447-8770