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NPI Code Detail

MEDICARE: CHILDREN'S PROGRAM

MEDICARE: CHILDREN'S PROGRAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorOR
2103TC0700XClinical PsychologistOR
3103TC2200XClinical Child & Adolescent PsychologistOR
42084P0804XChild & Adolescent Psychiatry PhysicianOR
52080P0006XDevelopmental - Behavioral Pediatrics PhysicianOR

General Provider Information

NPI Number : 1124187323
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S PROGRAM
Provider Business Mailing Address
First Line : 7707 SW CAPITOL HWY
Second Line :
City : PORTLAND
State : OR
Zip : 97219-2458
Country : US
Telephone Number : 503-452-8002
Fax Number :
Provider Business Practice Location Address
First Line : 7707 SW CAPITOL HWY
Second Line :
City : PORTLAND
State : OR
Zip : 97219-2458
Country : US
Telephone Number : 503-452-8002
Fax Number :
Authorized Official
Title or Position : CLINIC COORDINATOR
Name : MINDY J RANIK
Credential : M.S.
Telephone Number : 503-452-8002
Provider Enumeration Date : 12/06/2006
Last Update Date : 09/11/2025

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Directions to “CHILDREN'S PROGRAM ” Practice Location

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