Healthcare Provider Details

I. General information

NPI: 1932651775
Provider Name (Legal Business Name): NIKOLE RADFORD BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SW MARLOW AVE STE 200
PORTLAND OR
97225-5102
US

IV. Provider business mailing address

DEPT LA 22763
PASADENA CA
91185-2763
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax:
Mailing address:
  • Phone: 866-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberABA-IN-10179258
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: