Provider Demographics
NPI:1427556976
Name:REDDY, LAUREN NOELLE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NOELLE
Last Name:REDDY
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NOELLE
Other - Last Name:HYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:13110 SW TRIGGER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7689
Mailing Address - Country:US
Mailing Address - Phone:661-917-0827
Mailing Address - Fax:
Practice Address - Street 1:1851 NW CIVIC DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5566
Practice Address - Country:US
Practice Address - Phone:971-292-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-42682103K00000X
ORABA-B-10209084103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORABA-B-10209084OtherBEHAVIOR ANALYSIS REGULATORY BOARD
OR1-20-42682OtherBACB