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General NPI Number Information
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NPI Number | 1154254969
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Entity Type | Organization
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Legal Business Name | TINY WONDERS ABA LLC
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 7773 NW SPIREA ST
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City | PORTLAND
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State | OR
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Zip | 97229-7087
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Country | US
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Telephone | 503-389-5357
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Fax |
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Provider Business Mailing Address
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Address Line | 7773 NW SPIREA ST
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City | PORTLAND
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State | OR
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Zip | 97229-7087
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Country | US
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Telephone | 503-389-5357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATRINA KETTERER
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Credential |
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Telephone | 503-389-5357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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