Healthcare Provider Details

I. General information

NPI: 1356245583
Provider Name (Legal Business Name): SHANNA ROAST RBT, RBAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2378 NW IRVING ST
PORTLAND OR
97210-3225
US

IV. Provider business mailing address

1050 SW 160TH AVE APT 531
BEAVERTON OR
97006-5020
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-8349
  • Fax:
Mailing address:
  • Phone: 503-277-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-498440
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: