Provider Demographics
NPI:1780415737
Name:DALE, KADE PURCELL (BCBA)
Entity type:Individual
Prefix:MR
First Name:KADE
Middle Name:PURCELL
Last Name:DALE
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 1:1625 SAVAGE RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1760
Mailing Address - Country:US
Mailing Address - Phone:208-550-1223
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORNE AVE SE STE B250
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5193
Practice Address - Country:US
Practice Address - Phone:503-551-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1-24-74911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst