Provider Demographics
NPI:1134428055
Name:REED, JESSICA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SW BOND AVE UNIT 1816
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4576
Mailing Address - Country:US
Mailing Address - Phone:503-877-3996
Mailing Address - Fax:
Practice Address - Street 1:3720 SW BOND AVE UNIT 1816
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4576
Practice Address - Country:US
Practice Address - Phone:503-877-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1134428055Medicaid