Provider Demographics
NPI:1336608017
Name:WOOD, WILLIAM DENZEL (BCBA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DENZEL
Last Name:WOOD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 SE SALMON ST APT D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2468
Mailing Address - Country:US
Mailing Address - Phone:503-406-7641
Mailing Address - Fax:
Practice Address - Street 1:121 SW SALMON ST FL 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2908
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRBT-19-91156106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-67652OtherBACB CERTIFICATION NUMBER
RBT-19-91156OtherBACB- REGISTERED BEHAVIOR TECHNICIAN
ORABA-B-10235589OtherOREGON HEALTH LICENSING OFFICE