MEDICARE: DIANA KLESS MA, 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386926442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA KLESS MA, BCBA, LBA

Provider Business Mailing Address
First Line	:	9658 SW EVERETT TER
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-5456
Country	:	US
Telephone Number	:	310-864-1594
Fax Number	:

Provider Business Practice Location Address
First Line	:	10260 SW GREENBURG RD FL 4
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5500
Country	:	US
Telephone Number	:	310-865-0800
Fax Number	:	855-568-2494

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	05/02/2022

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