Provider Demographics
NPI:1922556232
Name:PLAY CONNECTIONS AUTISM SERVICES
Entity Type:Organization
Organization Name:PLAY CONNECTIONS AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-350-7050
Mailing Address - Street 1:1800 NW 169TH PL
Mailing Address - Street 2:B100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4848
Mailing Address - Country:US
Mailing Address - Phone:503-350-7050
Mailing Address - Fax:
Practice Address - Street 1:1800 NW 169TH PL
Practice Address - Street 2:B100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4848
Practice Address - Country:US
Practice Address - Phone:503-350-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10166920103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty