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General NPI Number Information
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NPI Number | 1700600442
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Entity Type | Individual
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Provider Name | RACHAEL SUSAN NYE BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 912 NE KELLY AVE
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City | GRESHAM
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State | OR
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Zip | 97030-5629
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Country | US
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Telephone | 480-608-5210
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Fax |
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Provider Business Mailing Address
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Address Line | 14435 S 48TH ST APT 2138
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City | PHOENIX
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State | AZ
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Zip | 85044-6451
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Country | US
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Telephone | 406-596-1098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ABA-B-10260793
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License Number State | OR
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