Provider Demographics
NPI:1598149445
Name:COOPER, SARAH (BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:COOPER
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 1:7125 SW 174TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6406
Mailing Address - Country:US
Mailing Address - Phone:503-406-8162
Mailing Address - Fax:
Practice Address - Street 1:7475 SW OLESON RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-7474
Practice Address - Country:US
Practice Address - Phone:971-804-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10168878103K00000X
1 14 9606103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1 14 9606OtherBEHAVIOR ANALYST CERTIFICATION BOARD
ORABA-B-10168878OtherOREGON HEALTH LICENSING BEHAVIOR ANALYST REGULATORY BOARD