MEDICARE: JESSICA REED M.A., BCBA, LBA

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
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134428055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA REED M.A., BCBA, LBA

Provider Business Mailing Address
First Line	:	3720 SW BOND AVE UNIT 1816
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-4576
Country	:	US
Telephone Number	:	503-877-3996
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 SW BOND AVE UNIT 1816
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-4576
Country	:	US
Telephone Number	:	503-877-3996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	05/26/2016

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