Provider Demographics
NPI:1306286802
Name:PHILLIPS, REBECCA (BCBA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 SW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3837
Mailing Address - Country:US
Mailing Address - Phone:206-915-9360
Mailing Address - Fax:
Practice Address - Street 1:16850 SW LEDGESTONE DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-5189
Practice Address - Country:US
Practice Address - Phone:206-915-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst