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NPI Code Detail

MEDICARE: SARA SHAUN GOODMAN MSP.ED., BCBA, LBA

MEDICARE: SARA SHAUN GOODMAN MSP.ED., 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
1103K00000XBehavior Analyst10186879OR

General Provider Information

NPI Number : 1669928768
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA SHAUN GOODMAN MSP.ED., BCBA, LBA
Provider Business Mailing Address
First Line : 6411 SE 60TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-6715
Country : US
Telephone Number : 720-394-6154
Fax Number :
Provider Business Practice Location Address
First Line : 18765 SW BOONES FERRY RD
Second Line :
City : TUALATIN
State : OR
Zip : 97062-8496
Country : US
Telephone Number : 503-612-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2016
Last Update Date : 06/17/2024

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