Provider Demographics
NPI:1750886453
Name:KAY, MICHELLE (RBAI)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KAY
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 1:1201 SE EVANS LOOP
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2283
Mailing Address - Country:US
Mailing Address - Phone:503-784-4903
Mailing Address - Fax:
Practice Address - Street 1:2120 SW JEFFERSON ST STE 200B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-7727
Practice Address - Country:US
Practice Address - Phone:503-784-4903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician