Provider Demographics
NPI:1124782131
Name:NORTHWEST ABA
Entity type:Organization
Organization Name:NORTHWEST ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIESCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:503-409-3659
Mailing Address - Street 1:4133 VICKIE CT
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OR
Mailing Address - Zip Code:97032-9544
Mailing Address - Country:US
Mailing Address - Phone:503-409-3659
Mailing Address - Fax:
Practice Address - Street 1:4133 VICKIE CT
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OR
Practice Address - Zip Code:97032-9544
Practice Address - Country:US
Practice Address - Phone:503-409-3659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1003275579Medicaid