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General NPI Number Information
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NPI Number | 1124187323
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Entity Type | Organization
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Legal Business Name | CHILDREN'S PROGRAM
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7707 SW CAPITOL HWY
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City | PORTLAND
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State | OR
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Zip | 97219-2458
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Country | US
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Telephone | 503-452-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 7707 SW CAPITOL HWY
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City | PORTLAND
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State | OR
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Zip | 97219-2458
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Country | US
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Telephone | 503-452-8002
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Fax |
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Authorized Official
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Title or Position | CLINIC COORDINATOR
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Name | MINDY J RANIK
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Credential | M.S.
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Telephone | 503-452-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State | OR
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