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NPI Code Detail

MEDICARE: YOUTH PROGRESS ASSOCIATION

MEDICARE: YOUTH PROGRESS ASSOCIATION
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1487080206
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUTH PROGRESS ASSOCIATION
Provider Business Mailing Address
First Line : 12141 NE HALSEY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220
Country : US
Telephone Number : 503-984-5961
Fax Number :
Provider Business Practice Location Address
First Line : 2333 SE 12TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5323
Country : US
Telephone Number : 503-235-0031
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : CHARLOTTE MEARDON
Credential :
Telephone Number : 503-233-6121
Provider Enumeration Date : 09/25/2013
Last Update Date : 11/02/2023

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Directions to “YOUTH PROGRESS ASSOCIATION ” Practice Location

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