Provider Demographics
NPI:1669928768
Name:GOODMAN, SARA SHAUN (MSPED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:SHAUN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSPED, BCBA, LBA
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPED, BCBA, LBA
Mailing Address - Street 1:6411 SE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6715
Mailing Address - Country:US
Mailing Address - Phone:720-394-6154
Mailing Address - Fax:
Practice Address - Street 1:18765 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8496
Practice Address - Country:US
Practice Address - Phone:503-612-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10186879103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst