Healthcare Provider Details

I. General information

NPI: 1992467088
Provider Name (Legal Business Name): NATALIE WILCOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 SW BARBUR BLVD STE 125
PORTLAND OR
97219-5405
US

IV. Provider business mailing address

9320 SW BARBUR BLVD STE 125
PORTLAND OR
97219-5405
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax:
Mailing address:
  • Phone: 877-264-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberB-10271900
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: