Provider Demographics
NPI:1699365346
Name:YAKSCOE, AMANDA (RBAI)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:YAKSCOE
Suffix:
Gender:F
Credentials:RBAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 SE 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2720
Mailing Address - Country:US
Mailing Address - Phone:614-507-8156
Mailing Address - Fax:
Practice Address - Street 1:3669 NE JOHN OLSEN AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5815
Practice Address - Country:US
Practice Address - Phone:503-927-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician