Provider Demographics
NPI:1306353958
Name:HALL, EVAYN TAYLOR
Entity type:Individual
Prefix:MRS
First Name:EVAYN
Middle Name:TAYLOR
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EVAYN
Other - Middle Name:TAYLOR
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 NE KELLY AVE
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:503-912-5502
Mailing Address - Fax:
Practice Address - Street 1:912 NE KELLY AVE
Practice Address - Street 2:SUITE 100C
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-912-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10178814106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician