Healthcare Provider Details

I. General information

NPI: 1902389018
Provider Name (Legal Business Name): KARISSA SINCLAIR-SKAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 NE 13TH AVE
VANCOUVER WA
98665-9605
US

IV. Provider business mailing address

7658 SW ALOMA WAY APT 3
PORTLAND OR
97223-7938
US

V. Phone/Fax

Practice location:
  • Phone: 360-984-3131
  • Fax:
Mailing address:
  • Phone: 541-505-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10225124
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: