Provider Demographics
NPI:1295007086
Name:KONG-SHAW, MELANIE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KONG-SHAW
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:5459 NW 176TH CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7931
Mailing Address - Country:US
Mailing Address - Phone:503-737-4693
Mailing Address - Fax:503-466-2436
Practice Address - Street 1:15100 SW KOLL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6026
Practice Address - Country:US
Practice Address - Phone:503-737-4693
Practice Address - Fax:503-466-2436
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst